The Comprehensive Treatment For Stage â…¢ Operable Rectal Cancer

Objective:To assess the recent efficacy of neoadjuvant chemotherapy ofstage Ⅲ operable rectal cancer, and explore the reasonable scheme ofcomprehensive treatment.Methods:A retrospective analysis clinical data and follow-up results of127patients with stage III colon cancer at general surgical treatment center of SecondHospital of Jilin University from January2010to January2013，of which35caseswere excluded,92cases in group. According to whether received neoadjuvantchemotherapy or not,the patients were randomly divided into comprehensivetreatment group (neoadjuvant chemotherapy plus surgery plus postoperativechemotherapy) and direct surgical group (surgery plus postoperativechemotherapy).38patients were in comprehensive treatment group and54patientswere in direct surgical group.；According to surgical procedures，the patients weredivided into laparoscopic group （43cases in laparoscopic rectal cancer surgery) andlaparotomy group (49cases in traditional open colorectal surgery).tumor size, tumorstage,sphincter preserving rate and recent survival rate and so on were comparedbetween comprehensive treatment group and direct surgical group. Intraoperativeconditions, postoperative recovery, complications, the total number of lymph nodesand the number of positive lymph nodes, hospitalization expenses and time werecompared between laparoscopic group and laparotomy group.Result:The tumor diameter is5.81cm on average which is compared with2.18cm after neoadjuvant chemotherapy with a reduced rate of62.4%.III A patientsclinical downstaging occurred in5cases, downstaging rate was55.5%. III B patientsclinical downstaging occurred in9cases, downstaging rate was56.2%.III C patientsclinical downstaging occurred in8cases, downstaging rate was61.5%. Though nocomplete remission (cCR) case in comprehensive treatment group,there were21cases of partial remission (cPR,55.2%),14cases of stable disease (SD,36.8%),3 cases of progression of disease (PD,7.8%).The total effective rate was55.2%. Theclinical benefit rate (eCR+cPR) was92.1%.In the distance from the anal verge ofless than6cm in colorectal cancer (n=57),22cases received neoadjuvantchemotherapy with a sphincter preserving rate of45.4%, and35cases.were dividedinto direct surgical group.with a sphincter preserving rate of20%.Thoughlaparoscopic operation time (155.1±25.2minutes) is longer than the traditionaloperation(124.4±25.6minutes), the amount of bleeding during operation andpostoperative drainage volume were significantly lower than that in traditionallaparotomy group(P <0.05),there was significant difference.There were statisticallynon-significant trend toward blood transfusion cases during operation,complications,the total number of lymph nodes and the number of positive lymph nodes（P＞0.05).In the comprehensive treatment group,18cases (accounting for47.3%)received laparoscopic surgical operation while20cases(accounting for52.6%)received the tradition open abdomen operation.By comparing the survival rates ofthe two groups, the survival rate had no significant difference(P>0.05).Conclusion:Neoadjuvant chemotherapy in patients with stage III coloncancer showed an efficacy in shrinking the tumor, reducing the clinical stage,improving sphincter preservation rate.It had no obvious effect on the recent survivalrate and whether it could increase long-term survival need a forward researchingstep.The advantage of laparoscopic colorectal surgery is less bleeding, fasterpostoperative recovery, shorter period in hospital than the tradition open colorectalsurgery. it is safe and worth popularizing.The prognosis of the patients who receivedneoadjuvant chemotherapy has no obvious relation with surgical procedures.