Radiation-induced injury on surgical margins: a clue to anastomotic leakage after rectal-cancer resection with neoadjuvant chemoradiotherapy?
Radiation-induced injury on surgical margins: a clue to anastomotic leakage after rectal-cancer resection with neoadjuvant chemoradiotherapy?
复制标题
手术边缘放射损伤：直肠癌切除新辅助放化疗后吻合口瘘的线索？
DOI：
10.1093/gastro/goy042
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发表时间：
2019-04-01
影响因子：
3.6
通讯作者：
Wang, Lei
中科院分区：
文献类型：
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作者：
Qin, Qiyuan;Zhu, Yaxi;Wang, Lei
背景目前关于直肠癌切除术后吻合口状况及其对吻合口漏影响的研究很少。本研究旨在探讨新辅助放化疗（nCRT）后前切除术手术边缘遗留的潜在放射性损伤及其与AL的关系。方法回顾性分析2014年至2015年期间，161例连续接受前切除术联合nCRT、无放射新辅助化疗（nCT）或无新辅助治疗的患者。使用特定的组织病理学评分和粘膜下层微血管密度来评估切除边缘的组织样本。倾向评分匹配用于平衡基线特征。分析了AL与组织病理特征的关系。结果54例nCRT患者中有13例发生AL， 48例nCT患者中有5例发生AL， 59例未接受新辅助治疗的患者中有7例发生AL。配对后比较显示中位（范围）组织病理学评分如下：近缘3 (0 - 8)vs 0 (0 - 3) vs 0 (0 - 2) (P < 0.001)；远端切缘4 (2-9)vs 0 (0 - 4) vs 0 (0 - 3) （P < 0.001）。相应的，平均（SD）微血管密度如下：近端边缘21.7 (7.9)vs 27.2 (8.6) vs 27.3 (9.4) (P = 0.003)；远端切缘18.1 (9.3)vs 25.2 (12.9) vs 24.9 (7.4) （P < 0.001）。在接受nCRT的患者中，AL与近端边缘组织病理学评分升高（P = 0.003）和微血管密度降低（P = 0.004）相关。结论直肠癌切除术后手术缘存在一定的辐射损伤。AL与近缘放射损伤加重有关。
Abstract Background Few studies on anastomotic condition after rectal-cancer resection and its effect on anastomotic leakage (AL) are available up to now. This study aimed to investigate potential radiation-induced injury left on surgical margins of anterior resection after neoadjuvant chemoradiotherapy (nCRT) and its association with AL. Methods We retrospectively identified 161 consecutive patients who underwent anterior resection with nCRT, neoadjuvant chemotherapy without radiation (nCT) or no neoadjuvant therapy between 2014 and 2015. Tissue samples of resection margins were assessed using a specific histopathological score and microvessel density in submucosa. Propensity score matching was used to balance the baseline characteristics. Association between AL and histopathological features was analysed. Results AL occurred in 13 of 54 patients undergoing nCRT, 5 of 48 patients undergoing nCT and 7 of 59 patients without neoadjuvant therapy. Comparisons after matching showed median (range) histopathological scores as follows: 3 (0–8) vs 0 (0–3) vs 0 (0–2) for the proximal margin (P < 0.001); 4 (2–9) vs 0 (0–4) vs 0 (0–3) for the distal margin (P < 0.001). Correspondingly, mean (SD) microvessel densities were as follows: 21.7 (7.9) vs 27.2 (8.6) vs 27.3 (9.4) for the proximal margin (P = 0.003); 18.1 (9.3) vs 25.2 (12.9) vs 24.9 (7.4) for the distal margin (P < 0.001). Among patients undergoing nCRT, AL was associated with increased histopathological score (P = 0.003) and decreased microvessel density (P = 0.004) on the proximal margin. Conclusions Surgical margins of rectal-cancer resection are exposed to certain radiation-induced injury after nCRT. AL is associated with aggravated radiation damage on the proximal margin.