Rectum modular dissection applied to radical anus-preserving surgery in men with low rectal cancer after neoadjuvant therapy

doi:10.3877/cma.j.issn.1674-6899.2024.03.004

Abstract

Abstract:

Objective

To validate the efficacy and safety of rectum modular dissection(RMD) in male patients with low and intermediate rectal cancer after neoadjuvant therapy.

Methods

Eligible patients were divided into the RMD group and the traditional rectum dissection (TRD) group. Demographic characteristics, tumor stage data, perioperative recovery and specimen pathology results of the enrolled patients were compared. patients′ genitourinary and bowel functions were also evaluated and compared. The study was registered with the China Clinical Trial Registry (ChiCTR2100052094).

Results

A total of 176 patients in Jan. 2020 to Jan. 2023 were enrolled in the study. There were 81 patients in the RMD group and 80 patients in the TRD group. There were no significant differences between the two groups in terms of age, body mass index, underlying disease, and tumor characteristics. Blood loss (P< 0.01), duration of surgery (P< 0.01), and length of hospital stay (P=0.04) were significantly less in the RMD group than in the TRD group. There was no statistically significant difference in the rate of positive margins of resected specimens (P= 0.10) or the integrity of the mesentery (P= 0.62) between the two groups, whereas the average number of peri-intestinal lymph nodes resected was higher in the RMD group than in the TRD group (P= 0.04). The 1-year disease-free survival rates in both groups remained similar (96.3% vs. 93.8%, P= 0.49). No patients died or developed distant metastases. The RMD group had a better assessment of erectile function (IIEF-5 score, P< 0.01), and assessment of bowel function (LARS score, P< 0.01) at 1 year after surgery.

Conclusion

In male patients after neoadjuvant treatment with lower rectal cancer, RMD is a reliable method to free the rectum that allows for a more standardized TME. It is expected to improve the patients′ oncologic prognosis and functional recovery.

Key words: Middle and low rectal cancer, Rectal modular dissection, Neoadjuvant therapy, Total mesorectal excision

Weijie Chen, Xiao Zhang, Yuxin Liu, Xiaoyuan Qiu, Ning Zhang, Guannan Zhang, Junyang Lu, Jiaolin Zhou, Guole Lin. Rectum modular dissection applied to radical anus-preserving surgery in men with low rectal cancer after neoadjuvant therapy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(03): 146-152.

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References 22

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	RMD组	TRD组	P值
入组患者数(例)	81	80
年龄(岁)	59.1±9.0	58.1±10.9	0.51
BMI (kg/m²)	24.4±3.0	24.4±3.2	0.89
基础病及病史[例(%)]			0.76
合并糖尿病	16(19.8)	7(8.8)
合并冠心病	8(9.9)	5(6.3)
腹部手术史	9(11.1)	3(3.8)
肿瘤情况
肿瘤大小(cm)	3.2±1.6	3.1±1.6	0.66
临床T分期[例(%)]
T2	13(16.0)	11(13.8)
T3～4	68(84.0)	69(86.2)	0.68
临床N分期[例(%)]
N0	22(27.2)	24(30.0)
N＋	59(72.8)	56(70.0)	0.69
距肛缘长度(cm)	6.5±2.0	7.2±2.7	0.06
低位直肠癌	22(27.2)	18(22.5)
中位直肠癌	59(72.8)	62(77.5)	0.49
位于直肠前壁	16(19.8)	14(17.5)
位于直肠侧壁及后壁	65(80.2)	66(82.5)	0.71

	RMD组	TRD组	P值
入组患者数(例)	81	80
年龄(岁)	59.1±9.0	58.1±10.9	0.51
BMI (kg/m²)	24.4±3.0	24.4±3.2	0.89
基础病及病史[例(%)]			0.76
合并糖尿病	16(19.8)	7(8.8)
合并冠心病	8(9.9)	5(6.3)
腹部手术史	9(11.1)	3(3.8)
肿瘤情况
肿瘤大小(cm)	3.2±1.6	3.1±1.6	0.66
临床T分期[例(%)]
T2	13(16.0)	11(13.8)
T3～4	68(84.0)	69(86.2)	0.68
临床N分期[例(%)]
N0	22(27.2)	24(30.0)
N＋	59(72.8)	56(70.0)	0.69
距肛缘长度(cm)	6.5±2.0	7.2±2.7	0.06
低位直肠癌	22(27.2)	18(22.5)
中位直肠癌	59(72.8)	62(77.5)	0.49
位于直肠前壁	16(19.8)	14(17.5)
位于直肠侧壁及后壁	65(80.2)	66(82.5)	0.71

	RMD组	TRD组	P值
入组患者数(例)	81	80
手术时长(min)	129.0±31.3	154.7±50.4	<0.01
出血量(ml)	35.2±27.7	59.4±57.2	<0.01
无预防性造口[例(%)]	22(27.2)	18(22.5)	0.49
并发症[例(%)]	8(9.9)	12(15.0)
吻合口漏[例(%)]	5(6.2)	7(8.7)
造口相关并发症[例(%)]	0	1(1.3)
尿潴留[例(%)]	3(3.7)	3(3.7)
肠梗阻[例(%)]	0	1(1.3)	0.66
Clavien-Dindo分级
Ⅰ～Ⅱ[例(%)]	8(9.9)	8(10.0)
Ⅲ～Ⅳ[例(%)]	0	4(5.0)	0.12
术后住院时长(d)(median，(P₂₅，P₇₅)	7(7，7)	7(7，8)	<0.01

	RMD组	TRD组	P值
入组患者数(例)	81	80
手术时长(min)	129.0±31.3	154.7±50.4	<0.01
出血量(ml)	35.2±27.7	59.4±57.2	<0.01
无预防性造口[例(%)]	22(27.2)	18(22.5)	0.49
并发症[例(%)]	8(9.9)	12(15.0)
吻合口漏[例(%)]	5(6.2)	7(8.7)
造口相关并发症[例(%)]	0	1(1.3)
尿潴留[例(%)]	3(3.7)	3(3.7)
肠梗阻[例(%)]	0	1(1.3)	0.66
Clavien-Dindo分级
Ⅰ～Ⅱ[例(%)]	8(9.9)	8(10.0)
Ⅲ～Ⅳ[例(%)]	0	4(5.0)	0.12
术后住院时长(d)(median，(P₂₅，P₇₅)	7(7，7)	7(7，8)	<0.01

	RMD组	TRD组	P值
入组患者数(n)	81	80
切缘阳性[例(%)]	2(2.5)	7(8.8)	0.10
系膜完整[例(%)]	78(96.3)	69(86.3)	0.62
标本完整度分级[例(%)]
完整	73(90.1)	65(81.3)
近完整	5(6.2)	10(12.5)
不完整	3(3.7)	5(6.2)	0.27
切除淋巴结总数(个)	14.3±6.5	12.5±5.0	0.05
肿瘤分化程度[例(%)]
高分化	15(18.5)	20(25.0)
中分化	49(60.5)	45(56.2)
低分化	17(21.0)	15(18.8)	0.61
病理T分期[例(%)]
ypT1-2	45(55.6)	52(65.0)
ypT3-4	36(44.4)	28(35.0)	0.22
病理N分期[例(%)]
ypN0	65(80.2)	67(83.8)
ypN＋	16(19.8)	13(16.3)	0.56

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