Хирургия и онкология. 2018; 8: 47-59
Комплексное лечение больных раком прямой кишки с синхронными отдаленными метастазами
https://doi.org/10.17650/2220-3478-2018-8-4-47-59Аннотация
Цель исследования — изучить непосредственные и отдаленные результаты хирургического, комбинированного и комплексного лечения больных метастатическим раком прямой кишки.
Материалы и методы. Данная работа основана на ретроспективном анализе проспективно собранной базы данных результатов лечения больных раком прямой кишки, которым проводилось хирургическое, комбинированное (операция и химиотерапия) и комплексное (химиолучевая терапия, операция и химиотерапия) лечение в проктологическом отделении ФГБУ«Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России в период с 1999 г. по июнь 2015 г. Исследуемые параметры включали общую выживаемость, частоту послеоперационных осложнений, частоту послеоперационной летальности, частоту осложнений химиолучевой терапии.
Результаты. Всего в исследуемые 3 группы вошло 366 пациентов. Общая 2-летняя выживаемость в 3-й группе (комплексное лечение) составила 83 % по сравнению с 40 % в 1-й и 2-й группах, медиана выживаемости — 43 мес по сравнению с 18 мес во 2-й группе и 14мес в 1-й группе, частота послеоперационных осложнений — 19 % в 1-й группе, 13,4 % — во 2-й, 15,1 % — в 3-й. Послеоперационная летальность (1,1 %) зафиксирована только в 3-й группе.
Выводы. Комплексный подход лечения позволяет значительно увеличить показатели общей выживаемости больных метастатическим раком прямой кишки без повышения риска послеоперационных осложнений.
Список литературы
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15. Snijders H.S., Wouters M.W., van Leersum N.J. et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 2012;38(11):1013—9. PMID: 22954525. DOI: 10.1016/j.ejso.2012.07.111.
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21. Забелин М.В., Гордеев С.С., Петров Л.О. и др. Роль антиангиогенных препаратов в лечении больных метастатическим колоректальным раком. Онкологическая колопроктология 2018;(1):11–9.
Surgery and Oncology. 2018; 8: 47-59
Comprehensive treatment of rectal cancer patients with synchronous distant metastases
https://doi.org/10.17650/2220-3478-2018-8-4-47-59Abstract
Objective: to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer.
Materials and methods. We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy.
Results. The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3.
Conclusion. Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.
References
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2. Cooray P., McKendrick J., Wong S.W. et al. Synchronised chemoradiation and systemic chemotherapy for patients presenting with simultaneously primary and metastatic rectal cancer. Eur J Cancer 2013;49(2):S506.
3. Van Dijk T.H., Tamas K., Beukema J.C. et al. Evaluation of short-course radio-therapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol 2013;24(7):1762—9. PMID: 23524865. DOI: 10.1093/annonc/mdt124.
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7. McMillan D.C., McArdle C.S. Epidemiology of colorectal liver metastases. Surg Oncol 2007;16(1):3— 5. PMID: 17493802. DOI: 10.1016/j.suronc.2007.04.008.
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14. Lee K.C., Ou Y.C., Hu W.H. et al. Meta-analysis of outcomes of patients with stage IV colorectal cancer managed with chemotherapy/radiochemotherapy with and without primary tumor resection. Onco Targets Ther 2016;9:7059—69. PMID: 27895498. DOI: 10.2147/OTT.S112965.
15. Snijders H.S., Wouters M.W., van Leersum N.J. et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 2012;38(11):1013—9. PMID: 22954525. DOI: 10.1016/j.ejso.2012.07.111.
16. Scheer M.G., Sloots C.E., van der Wilt G.J., Ruers T.J. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol 2008;19(11):1829—35. PMID: 18662955. DOI: 10.1093/annonc/mdn398.
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18. Vigano L., Karoui M., Ferrero A. et al. Locally advanced mid/low rectal cancer with synchronous liver metastases. World J Surg 2011;35(12):2788—95. PMID: 21947493. DOI: 10.1007/s00268-011-1272-7.
19. Manceau G., Brouquet A., Bachet J.B. et al. Response of liver metastases to pre-operative radiochemotherapy in patients with locally advanced rectal cancer and resectable synchronous liver metastases. Surgery 2013;154(3):528—35. PMID: 23601902. DOI: 10.1016/j.surg.2013.02.010.
20. Agas R.A.F., Co L.B.A., Jacinto J.C.K.M. et al. Neoadjuvant radiotherapy versus no radiotherapy for stage iv rectal cancer: a systematic review and meta-analysis. J Gastrointest Cancer 2018;49(4):389— 401. PMID: 30043227. DOI: 10.1007/s12029-018-0141-0.
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