The Research Of Neoadjuvant Therapy Combined With Total Mesorectal Excision For Treatment Of Advanced Rectal Cancer Under Multidisciplinary Team

Aim: To evaluate the efficacy and safety of neoadjuvant therapy combined with total mesorectal excision for treatment of advanced rectal cancer under multidisciplinary team from our hospital retrospectively.Method: 16 patients with advanced rectal adenocarcinoma were recruited between Jan 2015 to Jan 2016 from our departments,6 cases had stage Ⅱ,8 cases had stage Ⅲ,2 cases had stage Ⅳ,all patients had accepted individual neoadjuvant therapy from multidisciplinary team. All patients had received a total of 41 cycles neoadjuvant chemotherapy(XELOX 、 FOLFOX±bevacizumab, or capecitabine, or oxaliplatin+tegafur); all patients received preoperative radiotherapy(15cases had the CRT, the PTV= 42-50.4 Gy /20-28F;one case had the SCRT,PTV=25Gy/5F. Fourteen patients received concurrent chemoradiotherapy(13 patients concurrent chemoradiotherapy with fluoropyrimidines, one patient received concurrent chemoradiotherapy with XELOX regimen);The surgical operation was performed average 11.1 ± 5.9 weeks afterconcurrent chemoradiotherapy, following the principle of TME. The control group consists of 65 cases of rectal adenocarcinoma, they all only accepted total mesorectal excision by the same chief operator at the same time;13 cases had stageⅠ,43 cases had stageⅡ,eight cases had stage Ⅲ,one cases had stage Ⅳ.Result: The downstage rate of primary tumor and lymph node in neoadjuvant therapy group are 93.8% and 90.9%, respectively; the rate of pathologic complete response is 25.0%,including one case yp T4(6.2%),five cases yp T3(31.3%), six cases yp T2(37.5%), four cases yp T0(25.0%); 3 cases yp N1(18.7%), 13 cases yp N0(81.3%). Complete tumor resection rates in neoadjuvant therapy group and control group are all 100%.The total number of lymph nodes after surgery in neoadjuvant therapy group and control group are 4.4±3.0 and 11.7±4.9, respectively(P<0.001). The number of positive lymph nodes are 0.25 ±0.45 and 1.4±2.2, respectively(P<0.001). In neoadjuvant therapy group and control group, the operative duration are 4.8±1.6 hours and 4.1±1.2 hours( P=0.053), intraoperatve blood soss are 101.0ml and 81.4 ± 74.1ml(P=0.061), postoperative hospital stays are 18.2±12.7 days and 13.4±7.3days(P=0.052), postoperative morbidity are 37.5% and 35.4%(P=0.874),the rates of anastomotic leakage are 12.5% and 9.2%(P=1.000),respectively.Conlusion: Neoadjuvant therapy combined with total mesorectalexcision for treatment of advanced rectal cancer under multidisciplinary team is effective and safe, without increasing the operation difficulty,intraoperative bleeding, postoperative complications and postoperative hospitalization days, worth clinical promotion.