Clinical Efficacy Of Neoadjuvant Chemoradiotherapy Combined With Surgery For T₃N₊/T₄N_x Rectal Cancer

Objective:To compare the clinical efficacy of neoadjuvant chemoradiotherapy（nCRT）combined with direct surgery in the treatment of locally advanced rectal cancer,and to explore the effect of nCRT on its prognosis.Methods:A retrospective analysis of 260 patients with T₃N₊/T₄N_x middle and low rectal cancer treated in the Cancer Hospital of Xinjiang Medical University from January 2010 to January 2015,including 82parents in the neoadjuvant therapy group（nCRT+surgical treatment）,synchronous chemotherapy regimen was single-agent capecitabine（36 patients）or Xelox regimen（32patients）or FOLFOX regimen（14 patients）;and 178 patients in the direct surgery group.Perioperative conditions,postoperative pathology and three-year follow-up were analyzed in both groups.Results:11 patients（13.4%）in the neoadjuvant group achieved pathologic complete response（pCR）;there was no significant difference in the time of gastrointestinal function recovery（3d vs.3d）,postoperative hospital stay（16d vs.15d）,and unplanned reoperation rate（14.3%vs.7.3%）within 30 days between neoadjuvant therapy group and direct surgery group（P>0.05）.between the two groups,operation time（277.5min vs.240.0min）,intraoperative blood loss（100.0ml vs.80.0 ml）,number of lymph node dissection（9 vs.14）and perioperative complication rate（46.3%vs.25.3%）were statistically significant（P<0.05）.The three-year recurrence-free survival rate of the neoadjuvant treatment group（93.9%）was higher than that of the direct surgery group（81.3%）,the difference was statistically significant（P<0.05）,and there was no significant difference of the two groups in the sphincter preservation rate（35.9%vs.38.9%）,the three-year disease-free survival rate（66.2%vs.58.0%）and the three-year overall survival rate（81.1%vs.76.5%）（P>0.05）.Conclusion:Neoadjuvant chemoradiation can reduce the local recurrence rate of locally advanced rectal cancer,but it will increase the incidence of postoperative complications,but has no significant effect on sphincter preservation rate,disease-free survival rate and long-term survival rate.