| Part ?: Feasibility study of laparoscopic surgery combined with intraoperative radiotherapy for LARCObjective:To clarify the feasibility,safety and local control of laparoscopic surgery combined with intraoperative radiotherapy(IORT)for locally rectal cancer(LRRC),by comparing with matched laparoscopic surgery alone for LRRC.Methods:Between January 2012 and January 2016,15 LRRC patients cured by laparoscopic surgery with IORT were enrolled in a case-matched study.The patients were matched for gender,age,body mass index(BMI),type of operative procedure and tumor stage(AJCC,7th edition,2010).Perioperative recovery,short-term oncological results and postoperative follow-up were compared between the two groups.Results:A total of 45 samples were enrolled,with 15 samples in test group and 30 samples in control group.The mean operative time was(152.5±35.5min)in test group and(120.5±40.0min)in control group(p = 0.026).The mean number of harvested lymph nodes was(12.2±4.8)in test group and(12.6±4.2)in control group(p= 0.560).No difference was noted in lengths of proximal or distal resection margins,times until a liquid diet,or postoperative hospital stays(P>0.05).Negative distal resection margins(DRMs)were noted in all surgical specimens.The complication rate after surgery did not differ between test group(n = 3,20.0%)and control group(n = 5,16.7%).There was no intraoperative death or operative mortality within 30 days after surgery in either group.The middle follow-up time of both group was 24 months,the overall local recurrent rate in two groups during follow-up was4.4%,with no statistically significant difference(P = 0.545).Conclusion:Compared with pure laparoscopic surgery,laparoscopic surgery with IORT will increase the operation time,but in the other surgery-related indicators,short-term postoperative complications and postoperative recovery,the difference was not statistically significant.It is a safe and feasible technology for LARC patients.For local control rate,the effect of IORT is similar to adjuvant external beam radiation therapy,the difference was not statistically significant.Part ?: study of genitourinary function and defecating function after laparoscopic surgery combined with IORT for LARC patientsObjective:To discuss the protection value of intraoperative radiotherapy treatment for postoperative urogenital function and defecating function in LARC patients by comparing with postoperative adjuvant external beam radiation.Methods:Analyze the samples of two groups in Part I,and reclassify the samples into test group and control group by particular standard.Use questionnaire survey to estimate genitourinary function and defecating function of the postoperative patients by telephone follow-up and outpatient follow-up.The genitourinary function and defecating function of patients at different time points were performed by the total score of questionnaire,and the scores were statistically analyzed.Results:A total of 37 samples were enrolled,with 13 samples in test group and 24 samples in control group.There was no statistical difference in preoperative genitourinary function and defecating function in two groups(P>0.05).There was no statistical difference in the score of constipation and female sexual function at the time point of one month,three months and half year after operation in two groups(P>0.05);there was no statistical difference in the score of urinary function at the time point of one month after operation in two groups(P=0.616),but at the time point of three months(P=0.020)and half year(P=0.001),the differences are statistically significant;there was no statistical difference in the score of defecating incontinence at the time point of one month after operation in two groups(P=0.952),but at the time point of three months(P=0.045)and half year(P=0.025),the differences are statistically significant;there was no statistical difference in the score of male sexual function at the time point of one month after operation in two groups(P=0.809),but at the time point of three months(P=0.001)and half year(P=0.008),the differences are statistically significant.There were respectively two and three patients those who appeared radiation cystitis and anastomotic stenosis after postoperative adjuvant external beam radiation in control group,while there were no such cases in test group.Conclusion:Compared with adjuvant external beam radiation therapy,IORT can reduce the incidence of postoperative urinary dysfunction and incontinence for LARC patients,and can be able to remain the male patient's sexual function better.But there was no significant difference in postoperative constipation and reservations of female sexual function. |
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