Clinical efficacy of anus-preserving operation for ultra low rectal cancer / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical value of anus-preserving operation for ultra low rectal cancer.Methods The clinical data of 226 patients with ultra low rectal cancer who were admitted to the Yijishan Hospital between January 2009 and September 2013 were retrospectively analyzed.All the patients were divided into the anus-preserving group (117 patients underwent traditional or modified Dixon operation) and the control group (109 patients underwent Miles operation).The operation time,volume of intraoperative blood loss,number of lymph node dissection,recovery time of intestinal function,postoperative short-term amplications,local recurrence and distal metastasis of tumors,survival rate and quality of life in the 2 groups were analyzed.The measurement data with normal distribution were presented as (x) ± s and analyzed using t test,count data were analyzed using Pearson chi-square test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.The patients were followed up by regular out-patient examination and telephone interview up to September 2014.Results The traditional Dixon operation was performed on 108 patients,modified Dixon operation on 9 patients and Miles operation on 109 patients in the control group.The operation time and volume of blood loss were (117 ± 12) minutes and (110 ± 51) mL in the anus-preserving group,which were significantly different from (122 ± 8) minutes and (155 ± 44) mL in the control group (t =3.80,7.09,P ＜ 0.05).The number of lymph node dissected and time of intestinal function recovery were 13 ±4 and (2.8 ± 0.8)days in the anus-preserving group and 13 ±4 and (2.7 ± 0.7)days in the control group,respectively,with no significant difference (t =0.90,0.83,P ＞ 0.05).Among the 184 patients receiving postoperative chemotherapy,19 patients terminated the chemotherapy due to serious response to chemotherapy,17 patients received radiotherapy after chemotherapy,9 patients received interventional treatment for liver after chemotherapy and 42 patients didn't receive the chemotherapy.The incidence of perianal eczema were 15.38％ (18/117) in the anus-preserving group and 3.67％ (4/109) in the control group,with a significant difference between the 2 groups (x2=8.81,P ＜0.05).The cases of anastomotic leakage,intra-abdominal bleeding,intra-abdominal infection,postoperative urinary retention,infection of incision and incision dehiscence were 4,3,5,10,7 and 9 in the anus-preserving group,which were not significantly different from 0,2,4,11,8 and 5 in the control group (x2=1.86,0.14,0.05,0.16,0.19,0.94,P ＞ 0.05).One-hundred and ninety patients were followed up for a median time of 34.5 months (range,12.0-57.0 months).The rate of local tumor recurrence,rate of distant metastasis and 1-and 3-year survival rate were 8.55％ (10/117),5.98％ (7/117),94.8％ and 76.2％ in the anus-preserving group and 8.26％ (9/109),5.50％ (6/109),95.7％ and 76.1％ in the control group,with no significant difference between the 2 groups (x2 =0.01,0.02,0.08,0.00,P ＞ 0.05).The score of life quality was 66 ± 14 in the anus-preserving group,which was significantly higher than 49 ± 11 in the control group (t =10.13,P ＜ 0.05).Conclusion The anus-preserving operation for ultra low rectal cancer is safe and feasible based on strictly grasping operative indications,meanwhile,it can improve the postoperative life quality of patients.