| Purpose To investigate the postoperative efficacy of rectal cancer between neoadjuvant chemoradiotherapy(n CRT)and laparoscopic total mesorectal excision(TME)patients and rectal cancer patients undergoing laparoscopic TME the difference.Methods A retrospective review of the efficacy of 198 patients with rectal cancer after neoadjuvant chemoradiotherapy and 304 patients with rectal cancer undergoing surgery alone were reviewed from January 2015 to December 2018 in the Department of Oncology Surgery of the Second Affiliated Hospital of Fujian Medical University.Including intraoperative blood loss,length of operation,postoperative hospital stay,removal of drainage tube time,eating liquid diet,number of lymph node dissections and their positive rate,pericyclic circumcision margin positive rate,pathological complete response(pCR)rate,postoperative complications such as anastomotic leakage,anastomotic bleeding,anastomotic stenosis,postoperative intestinal obstruction,rectal vaginal fistula,etc.,as well as three-year local recurrence rate,three-year survival rate,fistula reentry rate,and anus preservation Rate,male sexual function,etc.Results The intraoperative blood loss of patients in the neoadjuvant chemoradiotherapy group and the TME group under direct laparoscopy were 73.36±14.12ml and 70.64±16.62ml(t=0.171,P=0.864),and the liquid eating time after operation was 1.99.±0.81d and 1.98±0.83d(t=0.021,P=0.983),postoperative pulmonary infection rates were 8.08%and 8.88%(χ~2=0.098,P=0.754),and rectal vaginal fistula rates were respectively 6.33%and 2.46%(χ~2=1.879,P=0.170),and the three-year survival rates were 73.74%and 75.33%(χ~2=0.161,P=0.688),and there was no significant difference between the two groups in these respects.The operation time was 140.49±12.24min and 110.53±8.92(t=31.681,P=0.000),the postoperative hospital stay was 11.94±2.60d and 10.16±2.02d(t=8.598,P=0.000),and the drainage tube removal time was 11.01±1.52d and 8.07±1.15d(t=24.546,P=0.000).The neoadjuvant group was significantly longer than the direct operation group.In postoperative pathology,the number of lymph node dissections in the two groups was 12.56±4.81 and 19.28±7.19(t=11.578,P=0.000),and the positive rates of lymph nodes were 8.20%and 13.89%(χ~2=560.766,P=0.000)The positive rates of circumcision were 5.05%and 11.18%,respectively(χ~2=5.641,P=0.027),and 11patients in the observation group achieved complete pathological remission,with a p CR rate of 5.56%.In terms of complications,the incidence of anastomotic leakage was9.50%and 4.31%(χ~2=4.682,P=0.030),and the incidence of anastomotic bleeding was7.26%and 2.75%(χ~2=4.883,P=0.027).The incidence of mouth stenosis was 7.82%and3.53%(χ~2=3.860,P=0.049),and the incidence of postoperative intestinal obstruction was 7.58%and 2.96%(χ~2=5.610,P=0.018).In terms of male sexual function after surgery,the proportion of patients with normal erectile function in the two groups was22.69%and 36.26%,and the proportion of patients with mild erectile dysfunction was31.93%and 32.42%,respectively.The proportion of people with moderate erectile dysfunction was 27.73%and 18.68%,and the proportions of severe erectile dysfunction were 17.65%and 12.64%,respectively.During the three-year follow-up,the local recurrence rates were 2.53%and 7.57%(χ~2=5.784,P=0.016),the fistula recurrence rates were 79.75%and 88.24%(χ~2=4.194,P=0.041),and anus preservation the rates were90.40%and 83.88%,respectively(χ~2=4.356,P=0.037).The results show that compared with patients undergoing laparoscopic TME after neoadjuvant chemoradiotherapy for rectal cancer and patients undergoing laparoscopic TME,the former increases the patient’s operation time,postoperative hospitalization time and extubation time,and reduces fistula return.The incidence rate of postoperative anastomotic leakage,anastomotic bleeding,anastomotic stenosis,and intestinal obstruction were significantly higher than those of the direct surgery group.In terms of postoperative sexual function,neoadjuvant chemoradiotherapy may cause erectile dysfunction in men.However,the neoadjuvant chemoradiotherapy group can significantly reduce the positive rate of postoperative lymph nodes and the positive rate of peripheral resection margins,improve the anus preservation rate and obtain a certain p CR rate.At the same time,neoadjuvant chemoradiotherapy does not increase the amount of bleeding during surgery.In terms of complications,it does not increase the risk of postoperative pulmonary infections and rectal vaginal fistulas.During the following three years of follow-up,the local recurrence rate in the neoadjuvant group decreased significantly,and there was no significant difference in the three-year survival rate between the two groups.Conclusion Neoadjuvant chemoradiation can bring certain benefits to patients with rectal cancer,but the possible complications should also attract the attention of clinicians. |
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