内镜下全层切除术治疗新辅助治疗后近临床完全缓解直肠癌的疗效及安全性研究  

Endoscopic full-thickness resection for the treatment of rectal cancer with near-clinical complete response after neoadjuvant therapy:A study on efficacy and safety

作　　者：董月伦 王燕 李冰[1] 杜嫣妘 阿依木克地斯·亚力孔 齐志鹏[1] 章娴[1] 叶乐驰[1] 王健[1] 许剑民[1] 钟芸诗[1] 贺东黎 DONG Yue-lun;WANG Yan;LI Bing;DU Yanyun;AYIMUKEDISI Yali-kong;Qi Zhi-peng;ZHANG Xian;YE Le-chi;WANG Jian;XU Jian-min;ZHONG Yunshi;HE Dong-li(Zhongshan Hospital,Fudan University,Shanghai 200032,China;Rongcheng Traditional Chinese Medicine Hospital,Rongcheng 264300,China;Xuhui Hospital of Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院,上海200032 [2]荣成市中医院,山东荣成264300 [3]复旦大学附属中山医院徐汇医院,上海200032

出　　处：《中国实用外科杂志》2025年第3期316-321,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82002515,No.82273025,No.82203460);上海市科学技术委员会科研计划项目(No.22JC1403003,No.22XD1402200)。

摘　　要：目的评估内镜下全层切除术(EFTR)在新辅助治疗后近临床完全缓解(ncCR)直肠癌病人中的可行性和安全性。方法回顾性分析2021年10月至2024年3月期间在复旦大学附属中山医院接受新辅助治疗的中低位直肠癌病例,筛选其中经再评估达到ncCR并接受EFTR的病人纳入研究。主要分析围手术期并发症、病理结果及短期随访数据。研究指标包括手术时间、整块切除率、R0切除率、术后并发症、排便功能评分(Wexner评分)及术后随访结果。结果共纳入9例cT2-3N0M0期病人,所有病人均接受以卡培他滨为基础的化疗联合同步放疗。所有病人顺利完成EFTR,平均手术时间为68.5 min。整块切除率及R0切除率均为100%。术后病理评估显示,6例仅残留黏膜内病变,3例病人残余肿瘤侵犯黏膜下层(ypT1期)。术后排便功能评估的Wexner评分平均为6.8分。在11~36个月(中位时间23个月)的随访期间,未观察到局部复发、远处转移或死亡病例。结论对于新辅助治疗后达到ncCR的直肠癌病人,EFTR是一种安全可行的治疗策略,能够实现高整块切除率及R0切除率,并在短期随访中显示良好的局部控制效果。然而,长期的肿瘤学预后仍需进一步评估。Objective To evaluate the feasibility and safety of endoscopic full thickness resection(EFTR)in rectal cancer patients achieving a near clinical complete response(ncCR)following neoadjuvant therapy.Methods A retrospective analysis was conducted on mid-to-low rectal cancer patients who underwent neoadjuvant therapy at Zhongshan Hospital,Fudan University between October 2021 and March 2024.Patients who,upon re-evaluation,achieved ncCR and subsequently underwent EFTR were included.The primary analysis was based on perioperative complications,pathological outcomes,and short term follow up data.Outcome measures included operative time,en bloc resection rate,R0 resection rate,postoperative complications,Wexner score for bowel function,and follow-up results.Results A total of 9 patients with cT2-3N0M0 rectal cancer were enrolled.All patients received capecitabine-based chemoradiotherapy.EFTR was successfully completed in all cases,with a mean operative time of 68.5 minutes.Both the en bloc resection and R0 resection rates were 100%.Postoperative pathological evaluation revealed that 6 cases had only residual mucosal lesions and 3 cases exhibited residual tumor invasion into the submucosa(ypT1).The mean postoperative Wexner score was 6.8.During a follow-up period of 11 to 36 months(median 23 months),no local recurrence,metastasis or death were observed.Conclusion For rectal cancer patients achieving ncCR after neoadjuvant therapy,EFTR appears to be a safe and feasible treatment strategy that attains high en bloc and R0 resection rates and favorable local control during short-term follow-up.Nonetheless,further evaluation is required to determine long-term oncological outcomes.

关 键 词：进展期直肠癌 器官保留 内镜下全层切除术 新辅助放化疗 安全性及有效性 

分 类 号：R6[医药卫生—外科学]