Evaluation Of Different Surgical Methods For Low Rectal Cancer After Neoadjuvant Therapy

Research background and objective In China,the incidence of colorectal cancer ranks third in the incidence of all malignant tumors,among which the incidence of rectal cancer accounts for about65% of the incidence of colorectal cancer,of which the proportion of patients with middle and low rectal cancer is the largest among all patients.Surgical treatment is now the most important means for the treatment of rectal cancer.Miles was introduced in 1908.In 1939,Dixon proposed Dixon surgery.Both surgical procedures have become the standard treatment for patients with rectal cancer.In1982,Heald proposed the concept of total mesorectal excision(TME),which led to a breakthrough in the surgical treatment of patients with rectal cancer.At the end of the20 th century,after Frei proposed the concept of neoadjuvant treatment,the clinical significance and value of neoadjuvant therapy combined with TME in the treatment of low rectal cancer gradually attracted people's attention.The NCCN guidelines for rectal cancer treatment recommend the use of preoperative treatment combined with TME radical treatment in patients with locally advanced rectal cancer(T3/T4,N+).This article focuses on the clinical efficacy of Dixon anal sphincter preservation and Miles non-preserving sphincter surgery in patients with low rectal cancer after neoadjuvant therapy,and studies the value of sphincter preserving surgery.MethodsWe collected 151 patients with low rectal cancer in our general surgery from January 2010 to January 2012.All patients underwent neoadjuvant treatment before surgery.Patients were divided into two groups according to different surgical methods: 87 patients in the Dixon group.Sixty-four patients in Miles group.General conditions,operative time,intraoperative blood loss,postoperative pathological stage,incidence of postoperative complications,incidence of urination dysfunctions,local recurrence rate,distant metastasis rate,5-year overall survival(5-OS)and 5-year disease-free survival(5-DFS)were compared in both groups,and analyze the clinical factors that affected recurrence.SPSS21.0 software was used for statistical analysis.P<0.05 indicated that the difference was statistically significant.Results There was no significant difference in the general condition between the two groups(P>0.05).The tumor diameter is significantly lower in the Dixon group than in the Miles group,and the distance from the lower margin of the tumor to the anal margin is lower than that of the Miles group,the differences were statistically significant(P<0.05).The operation time of the Dixon group was 104.9±16.4 min,which was significantly lower than the Miles group's operation time of 147.7±26.5min.The difference was statistically significant(P<0.05).The median blood loss in the Dixon group was 120 ml,which was lower than the median blood loss in the Miles group(350 ml).The difference was statistically significant(P<0.05);the difference in postoperative pathological stage between the two groups was significant.No statistical significance was found(P=0.708).The postoperative complication rate was 16.1% in the Dixon group,which was lower than the Miles group.But the difference was not statistically significant(P=0.115).The rate of postoperative urination dysfunction in the Dixon group was 8%,which was significantly lower than that of the Miles group(25%),which was statistically significant(P=0.004).The rate of postoperative sexual dysfunction in patients with Dixon was 5.5%,and the rate of postoperative sexual dysfunction in Miles patients was 26.8%,which was statistically significant(P=0.008).The local recurrence rate of the Dixon group was 8.1%,which was lower than that of the Miles group,which is 18.8%,and the difference was statistically significant(P=0.046).The distant metastasis rate in Dixon patients was 24.1%,which was lower than the distant metastasis rate of 35.9% in Miles patients.However,the difference between the two groups was not statistically significant(P=0.115).5-year overall survival was 67.5% in the Dixon group,the 5-year overall survival rate was significantly higher in the patients with Dixon group than in the Miles group(51.6%)(P=0.049).The 5-year disease-free survival rate in the Dixon group was 59.7%,and the overall survival rate was 43.8% in the Miles group,and the difference was statistically significant(P=0.043).The Kaplan-Meier survival analysis suggested that the overall survival of the Dixon group was better than that of the Miles group(P=0.006);Univariate and multivariate analysis showed that patients with positive circumferential margin(CRM+),later stage,younger age,and Miles surgery were prone to local recurrence.Conclusions Low rectal cancer patients received very good results after preoperative treatment for anus-sparing surgery,which not only protected the patients with low rectal cancer from permanent stoma,but also had little effect on urinary function and sexual function.Dixon surgery in patients with low rectal cancer does not affect the long-term survival of patients,and is due to Miles in the local recurrence rate.Patients with low rectal cancer should be treated with sphincter preserving surgery to obtain better quality of life.For some low rectal cancer patients,anal surgery can be considered.