A Comparative Study Of Short-term And Long-term Curative Effects Of The Minimally Invasive Surgery And Radical Surgery In Low Rectal Cancer With Almost-cCR(near-cCR) After Neoadjuvant Therapy

Objectve: To summarize the data of patients with low rectal cancer who achieved almost-c CR after neoadjuvant therapy and underwent the minimally invasive surgery or radical surgery,and compare the recovery time,the differences in local recurrence rate,disease-free survival rate at 1year and 2 years postoperatively,postoperative complications,and postoperative quality of life.Methods: We had retrospectively analyzed clinical,pathological and follow-up data of72 cases of locally advanced low rectal cancer reaching almost-c CR(near-c CR)after neoadjuvant therapy in the Liaoning cancer hospital,Sun Yat-sen University Cancer Hospital and Harbin Medical University Affiliated Cancer Hospital from January2013 to June 2018.According to the different surgical procedures,patients with low rectal cancer who achieved almost-c CR or c CR(recurrence during watch and wait)before surgery were divided into the minimally invasive surgery group and a radical surgery group,and the the minimally invasive surgery group received a local resection or transanal endoscopic minimally invasive surgery(Transanal Endoscopic Microsurgery,TEM),radical surgery group received low anterior resection,Hartmann surgery or Miles surgery.Follow-up every three months after surgery and record the data of postoperative recovery,tumor recurrence,metastasis,survival and collect the patient’s quality of life information through questionnaires.We analyse statistical data,and evaluate the postoperative recovery time of the two surgical methods,the incidence of complications,local recurrence rate,survival rate after 1 year and 2 years after surgery,quality of life was concluded as well.Results: 72 patients were included,of which 24 patients were included in the minimally invasive surgery group and 48 patients were included in the radical surgery group.The operation time,postoperative feeding time,postoperative hospital stay and total hospitalization days were compared between the two groups.The minimally invasive surgery group was better than the radical surgery group,and the difference was statistically significant(P<0.05).Postoperative complications occurred,The difference in incidence was not statistically significant.The 1-year disease-free survival rate and the 2-year disease-free survival rate were 100% in both groups.The local recurrence rate was 0 in both groups after operation in one year and two years.The average survival time of the minimally invasive surgery group was 46.93 months,and the average survival time of the radical surgery group was 47.78 months,and the difference was not statistically significant(P>0.05).The QOL rating scale was used to evaluate the postoperative quality of life of the two groups.The QOL score scale showed that the quality of life afterthe minimally invasive surgery was significantly better than that of the radical surgery group.The difference was statistically significant(P <0.05).According to the Wexner score of 2 weeks after anal incontinence,the difference of anal incontinence between the two groups was statistically significant(p<0.001),and the other differences were not statistically significant.Conclusion: Patients with rectal cancer who have reached almost-cCR after neoadjuvant therapy are safe in oncology.Compared with radical surgery,the operation time and hospitalization time are shorter,and the incidence of complications is significantly lower.The patient’s postoperative quality of life has high,but the evaluation criteria should be strictly evaluated,and regular review,because of the similar long-term prognosis,lower colostomy rate and good functional retention,this treatment optionare is worth discussing with the patient.