| [Research Background and Objective]In recent years, with the wide application of neoadjuvant therapy and the continuous improvement of radical operations, a great development has been made on the treatment and prognosis of locally advanced rectal cancer and a significant improvement has been made on the total survival rate and local recurrence rate. our country’s ministry of health of colorectal cancer, NCCN and ESMO of rectal cancer treatment guidelines, have pointed out that some patients with advanced colorectal cancer should first receive neoadjuvant chemotherapy in 8-12 weeks after TME surgery, postoperative according to the pathological staging decide whether adjuvant chemotherapy is needed. As for patients with middle and low rectal cancer, especially low rectal cancer, in order to achieve RO resection, anus has to be resected with tumor and perpetual colostomy is made on the abdominal wall. These measures have caused great influence on the mentality and physiology function of patients. There are individual differences tumor regression in patients with colorectal cancer after neoadjuvant therapy, it was reported that approximately 20-30% of patients achieved clinical complete remission,10-20% of patients achieved pathologic complete remission, partial remission most patients, but also still does not alleviate or progression of a small number of patients. Therefore, since 2004, researchers have proposed "wait and see" strategy for patients who had complete clinical relieve after chemotherapy. After receiving neoadjuvant therapy, patients with rectal cancer had individual difference. Nearly 20-30% of patients achieved complete clinical remission, 10-20% of the patients achieved complete pathological remission, most patients had incomplete remission and still a few patients got no remission or still progressed. Patients who have selected "wait and see" treatment strategy cannot only avoid complications caused by radical operation but can also avoid decreasing living quality due to colostomy. But among these patients, the local the local recurrence rate is relatively high and it is important to find out which kind of remedy treatment can be of benefit to patients. The study on the recent literature, the rate of local recurrence in locally advanced lower after neoadjuvant therapy clinical complete remission in patients with rectal cancer choice "wait and see" or treatment in two ways, distant metastasis rate, short-term and long-term survival were Meta-analysis, and the "wait and see" group of patients with local recurrence after different treatment strategies affect long-term survival of patients with survival analysis to assess the efficacy of different treatment strategies for the new adjuvant therapy after clinical complete remission in low locally advanced rectal cancer treatment options strategies provide guidance and basis.[Research methods]Literature search in Pubmed, CNKI and WanFang, retrieve keywords "rectal cancer", "rectal adenocarcinoma", "rectal neoplasms", "neoadjuvant therapy", "preoperative therapy", "radiochemotherapy", "clinical complete response", "non-operative", "local recurrence", including the above Chinese keywords. Collected in Advanced Mid-lower Rectal Cancer get complete clinical response after chemotherapy relevant literature, collecting a total of 14 literatures were included, the relevant data collation analyzed to obtain the observation group and surgery group about 2 year local recurrence, distant metastasis, progression-free survival and overall survival; 5-year local recurrence, distant metastasis, progression-free survival and overall survival. Finally, get "wait and see" policy of local recurrence after treatment, patient-related treatment, partial resection and radical resection of different treatment options and prognosis of measures.[Result]1. Short-term survival analysis(1) 2 years local recurrence rate in observation group patients is higher than the treatment group (OR=3.34,95% CI:1.17～9.55, P=0.024).(2) There is no difference in 2 years distant metastasis rate between the observation group with the treatment group (OR=0.48,95% CI:0.17～1.41, P= 0.183).(3) There is no difference in 2 years progression-free survival between the observation group with the treatment group (OR=1.36,95% CI:0.55～3.36, P= 0.502).(4) There is no difference in 2 years overall survival between the observation group with the treatment group (OR=0.31,95% CI:0.08～1.22, P=0.94).2. Long-term survival analysis(1) 5 years local recurrence rate in observation group patients is higher than the treatment group (OR=4.19,95% CI:1.76～9.98, P=0.001).(2) There is no difference in 5 years distant metastasis rate between the observation group with the treatment group (OR=0.95,95% CI:0.48～1.92, P= 0.890).(3) There is no difference in 5 years progression-free survival between the observation group with the treatment group (OR=2.07,95% CI:1.10-3.89, P= 0.24).(4) There is no difference in 5 years overall survival between the observation group with the treatment group (OR=0.92,95% CI:0.46～1.84, P=0.814).3. Observation group of patients with local recurrence after different treatment strategies for its survival influence survival analysisSurvival analysis results suggest that Clinic complete response in patients with local recurrence after the observation period, selection of cutting treatment (including endoscopic resection or anal bump local resection) in patients with long-term survival with no difference between the treatment of patients undergoing radical surgery (log rank=2.99; P=0.0838).[Conclusion]The Middle and low locally advanced colorectal cancer after preoperative treatment to obtain clinical complete remission, observation and treatment groups in the short-term and long-term survival analysis, the observation group of 2-year and 5-year local recurrence is higher than the treatment group,2-year and 5-year no difference in distant metastasis and treatment group, indicating that metastasis and wehter primary tumor resection no significant correlation.2-year and 5-year Disease-free survival and overall survival were not different, that is, patients with preoperative clinical obtained complete remission, "wait and see" strategy is a safe therapeutic treatment options. In the "wait and see" treatment strategy group of local recurrence patients, of indifference lifetime of a local resection and radical surgery group, the same description of the patient after the "wait and see" treatment strategies for local recurrence can still choose local excision as savage treatment, so that, the rate of sphincter preservation in patients increased and quality of life improved. |
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