Long-term outcomes and failure patterns after laparoscopic intersphincteric resection in ultralow rectal cancers

作     者：Wen-Long Qiu Xiao-Lin Wang Jun-Guang Liu Gang Hu Shi-Wen Mei Jian-Qiang Tang 

作者机构：Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of General SurgeryThe Second Hospital of YulinYulin 100021Shaanxi ProvinceChina Department of General SurgeryPeking University First HospitalBeijing 100021China 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2023年第15卷第6期

页      面：1104-1115页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：National Natural Science Foundation of China Beijing Nature Fund Beijing Natural Fund Haidian Special [L222054] 

主　　题：Rectal cancer Intersphincteric resection Laparoscopic surgery Recurrence Risk factors 

摘      要：BACKGROUND Intersphincteric resection(ISR),the ultimate anus-preserving technique for ultralow rectal cancers,is an alternative to abdominoperineal resection(APR).The failure patterns and risk factors for local recurrence and distant metastasis remain controversial and require further *** To investigate the long-term outcomes and failure patterns after laparoscopic ISR in ultralow rectal *** Patients who underwent laparoscopic ISR(LsISR)at Peking University First Hospital between January 2012 and December 2020 were retrospectively *** analysis was performed using the Chi-square or Pearson s correlation *** factors for overall survival(OS),local recurrence-free survival(LRFS),and distant metastasis-free survival(DMFS)were analyzed using Cox *** We enrolled 368 patients with a median follow-up of 42 *** recurrence and distant metastasis occurred in 13(3.5%)and 42(11.4%)cases,*** 3-year OS,LRFS,and DMFS rates were 91.3%,97.1%,and 90.1%,respectively Multivariate analyses revealed that LRFS was associated with positive lymph node status[hazard ratio(HR)=5.411,95%confidence interval(CI)=1.413-20.722,P=0.014]and poor differentiation(HR=3.739,95%CI:1.171-11.937,P=0.026),whereas the independent prognostic factors for DMFS were positive lymph node status(HR=2.445,95%CI:1.272-4.698,P=0.007)and(y)pT3 stage(HR=2.741,95%CI:1.225-6.137,P=0.014).CONCLUSION This study confirmed the oncological safety of LsISR for ultralow rectal *** differentiation,(y)pT3 stage,and lymph node metastasis are independent risk factors for treatment failure after LsISR,and thus patients with these factors should be carefully managed with optimal neoadjuvant therapy,and for patients with a high risk of local recurrence(N+or poor differentiation),extended radical resection(such as APR instead of ISR)may be more effective.