Lancet Gastroen Hepatol:短期放疗联合经肛门内镜显微手术治疗早期直肠癌

2021-01-26 MedSci原创 MedSci原创

对于早期直肠癌患者,短期放疗后进行经肛门内镜显微手术在疾病控制方面的效果与全直肠系膜切除相当,但在患者生活质量改善方面优于全直肠系膜切除

全直肠系膜根治性手术切除是局部直肠癌的标准护理方案,虽然肠系膜切除可有效控制肿瘤,但患者术后长期的肠道、膀胱和性功能障碍对患者生活质量(QOL)产生不良影响。在这一背景下,近日研究人员考察了基于器官保护的治疗策略对患者疾病控制及生活质量的影响。
 
TREC研究在英国21个医疗中心开展,成年直肠腺癌患者参与,患者肿瘤分期T2及以下,肿瘤最大直径不超过30mm,无淋巴结受累或转移,随机接受器官保护治疗策略或全直肠系膜切除,器官保护治疗策略组患者接受8-10周的短期放疗,随后进行经肛门内镜显微手术,若肛门内镜显微手术样本病理检测提示局部复发风险增加时,则进行全直肠系膜切除。研究的主要终点为术后12、18以及24个月评估的治疗效果、安全性及患者生活质量。
 
55名患者参与研究,其中器官保护治疗策略组27人,全直肠系膜切除组28人。术后30天,无患者死亡,但器官保护组1名患者在转为全直肠系膜切除后,在术后6个月死亡。器官保护组27名患者中,8人接受了全直肠系膜切除(30%)。器官保护组27名患者中,4人(15%)报告了严重不良事件,而全直肠系膜切除组28名患者中,11人报告了严重不良事件(39%)。器官保护组最常见的不良事件为经肛门内镜显微手术后直肠出血或疼痛,全直肠系膜切除组最常见的不良事件为吻合口瘘、肾损伤、心脏停搏和肺炎。器官保护组27名患者中,8人对放疗有应答(30%)。器官保护组患者在肠道毒性、生活质量和功能评分方面优于全直肠系膜切除组,效果持续至36个月。
 
研究认为,对于早期直肠癌患者,短期放疗后进行经肛门内镜显微手术在疾病控制方面的效果与全直肠系膜切除相当,但在患者生活质量改善方面优于全直肠系膜切除
 
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    2021-07-11 howi
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topicList=[TopicDto(id=81144, encryptionId=c8168114412, topicName=肛门)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39bc29444908, createdName=hxj0127, createdTime=Mon Aug 02 06:53:50 CST 2021, time=2021-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073231, encodeId=6d6020e3231f6, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Fri Oct 29 00:53:50 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262224, encodeId=7e22126222422, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290764, encodeId=8c9f1290e6423, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427486, encodeId=10f7142e486ce, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
    2021-08-02 hxj0127
  5. [GetPortalCommentsPageByObjectIdResponse(id=2079959, encodeId=28f820e9959d3, content=<a href='/topic/show?id=6b1ee8453a6' target=_blank style='color:#2F92EE;'>#经肛门内镜显微手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78453, encryptionId=6b1ee8453a6, topicName=经肛门内镜显微手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb3a261, createdName=liuxiaona, createdTime=Fri Apr 09 17:53:50 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712682, encodeId=c6231e1268259, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=81144, encryptionId=c8168114412, topicName=肛门)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39bc29444908, createdName=hxj0127, createdTime=Mon Aug 02 06:53:50 CST 2021, time=2021-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073231, encodeId=6d6020e3231f6, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Fri Oct 29 00:53:50 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262224, encodeId=7e22126222422, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290764, encodeId=8c9f1290e6423, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427486, encodeId=10f7142e486ce, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
    2021-10-29 许安
  6. [GetPortalCommentsPageByObjectIdResponse(id=2079959, encodeId=28f820e9959d3, content=<a href='/topic/show?id=6b1ee8453a6' target=_blank style='color:#2F92EE;'>#经肛门内镜显微手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78453, encryptionId=6b1ee8453a6, topicName=经肛门内镜显微手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb3a261, createdName=liuxiaona, createdTime=Fri Apr 09 17:53:50 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712682, encodeId=c6231e1268259, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, 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objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290764, encodeId=8c9f1290e6423, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427486, encodeId=10f7142e486ce, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2079959, encodeId=28f820e9959d3, content=<a href='/topic/show?id=6b1ee8453a6' target=_blank style='color:#2F92EE;'>#经肛门内镜显微手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78453, encryptionId=6b1ee8453a6, topicName=经肛门内镜显微手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb3a261, createdName=liuxiaona, createdTime=Fri Apr 09 17:53:50 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712682, encodeId=c6231e1268259, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=81144, encryptionId=c8168114412, topicName=肛门)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39bc29444908, createdName=hxj0127, createdTime=Mon Aug 02 06:53:50 CST 2021, time=2021-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073231, encodeId=6d6020e3231f6, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Fri Oct 29 00:53:50 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262224, encodeId=7e22126222422, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, 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href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
  8. 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href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
    2021-01-28 gwc384
  9. [GetPortalCommentsPageByObjectIdResponse(id=2079959, encodeId=28f820e9959d3, content=<a href='/topic/show?id=6b1ee8453a6' target=_blank style='color:#2F92EE;'>#经肛门内镜显微手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78453, encryptionId=6b1ee8453a6, topicName=经肛门内镜显微手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb3a261, createdName=liuxiaona, createdTime=Fri Apr 09 17:53:50 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712682, encodeId=c6231e1268259, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, 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objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jan 26 22:53:50 CST 2021, time=2021-01-26, status=1, ipAttribution=)]
    2021-01-27 曹江波

    0

  10. 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href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Jan 28 10:53:50 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=920285, encodeId=73fb920285ee, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55555437851, createdName=曹江波, createdTime=Wed Jan 27 14:11:10 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034146, encodeId=3d1f10341468e, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, 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    2021-01-26 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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