Objective: To analyze the clinical-pathological data of patients with locally advanced rectal cancer who underwent modified total neoadjuvant therapy (TNT), and to evaluate the safety and efficacy of radical surgery after modified total neoadjuvant therapy. Methods: The clinical-pathological data of 30 locally advanced rectal cancer patients who underwent modified TNT (mTNT) followed by radical resection were retrospectively analyzed. The surgical procedure, postoperative complications, tumor regression grade, tumor downstaging and prognosis were analyzed. Results: The 30 patients included 24 males and 6 females with a median age of 55.5 years. All patients underwent radical surgery after neoadjuvant therapy, 14 patients received low anterior resection, 14 patients received abdominal perineal resection, and the other 2 patients received Hartmann procedure. All patients achieved R0 resection with a median operative time 220 minutes and the median intraoperative blood loss was 200 ml. The morbidity of postoperative complications was 20% (6/30), including dysuria in 2 patients, delayed healing of perineal incision in 2 patients, intestinal obstruction in 1 patient and pelvic hemorrhage in 1 patient. The median time to first flatus after surgery was 3 days and the median postoperative hospital stay was 8 days. Postoperative pathological results showed that 15 patients (50.0%) had severe tumor regression, including 4 patients (13.3%) achieved pathological complete response (pCR), 12 patients (40.0%) had moderate tumor regression, and 3 patients (10.0%) had minor tumor regression. Twenty patients had detailed pre-treatment clinical stage, and among those 20 patients, 15 patients (75.0%) and 13 patients (65.0%) achieved downstaging of tumor T stage and N stage, respectively. Only 2 patients appeared distant metastasis, and no patient had local recurrence. Conclusions: For locally advanced rectal cancer patients, mTNT doesn't increase the morbidity of postoperative complication and is a safe and effective treatment strategy with satisfactory short-term result.
目的： 探讨局部晚期直肠癌患者接受改良全程新辅助治疗后行外科手术的安全性和有效性。 方法： 收集30例接受改良全程新辅助治疗后手术的局部晚期直肠癌患者的临床病理资料，分析术中情况、术后并发症、肿瘤退缩分级、病理降期以及患者的预后情况。 结果： 30例患者中，男24例，女6例；中位年龄55.5岁。在新辅助治疗后，所有患者均接受了标准的直肠癌全系膜切除，其中行低位前切除术14例，行腹会阴联合切除术14例，行Hartmann术2例。中位手术时间为220 min，中位术中出血量为200 ml。30例患者均达到了R0切除。6例(20.0%)患者出现术后并发症，分别为排尿困难(2例)、会阴切口延迟愈合(2例)、肠梗阻(1例)和盆腔出血(1例)。术后肠道恢复排气的中位时间为3 d，中位住院时间为8 d。术后病理结果显示，重度治疗反应15例(50.0%)，其中包括病理完全缓解4例(13.3%)；中度治疗反应12例(40.0%)；轻度治疗反应3例(10.0%)。20例患者具有详细的治疗前肿瘤信息，与治疗前临床分期对比，15例(75.0%)患者达到了ypT分期降期，13例(65.0%)患者达到了ypN分期降期。术后随访，无局部复发患者，仅2例患者出现远处转移。 结论： 对于高复发风险的局部晚期直肠癌患者，改良的全程新辅助治疗并不增加术后并发症的发生率，且具有较好的近期疗效，是安全有效的治疗模式。.
Keywords: Modified total neoadjuvant therapy; Operative complication; Radical surgery; Rectal neoplasms.