Clinical Effect Analysis Of Preoperative Chemoradiotherapy In Patients With Mid-low Rectal Cancer Who Underwent MRI Assessed T3N0 Stage And Absent Mesocretal Fascia Invasion

Objective:To investigate the clinical effect of neoadjuvant chemoradiotherapy for patients with mid-low rectal cancer who underwent MRI assessed T3N0 stage and absent mesocretal fascia invasion,In order to provide help for the treatment of patients with T3N0 rectal cancer.Methods:Clinical data of patients with mid-low rectal cancer who underwent MRI assessed T3N0 and absent mesocretal fascia were collected from January 2007 to December 2012 in The Department of General Surgery,Provincial Hospital of The Anhui Medical University..Patients were divided into the NCRT group and the control group according to the presence or absence of neoadjuvant chemoradiation.Preoperative general conditions,postoperative pathological data and perioperative data were compared between the two groups,including the degree of tumor differentiation,tumor size,TNM staging,operation time,rectal cancer surgery(sphincter preserving rate),the rate of terminal ileostomy,the incidence of postoperative complications and postoperative adjuvant chemotherapy were analyzed.The effect of preoperative neoadjuvant radiochemotherapy on the pathology and perioperative period was analyzed.The prognosis data of patients were compared between the two groups in local recurrence(LR)rate and Overall survival(OS)rate of 5 years.Results: Pathological data comparison:The average tumor size of NCRT group was 2.47±0.60 cm,while that of the control group was 4.22 ± 0.49 cm.The tumor volume of NCRT group was significantly smaller than that of the control group(P<0.05).The tumor stage(including tumor invasive depth T stage and TNM stage)were significantly lower than those in the control group(P<0.05),but there was no significant difference between the NCRT group and the control group in the degree of differentiation,distal resection margin(DRM),proximal resection margin(PRM),the positive rate of circumferential margin and the rate of vascular invasion.Perioperative data comparison: The sphincter preservation rate,operation time,intraoperative blood loss,terminal ileostoma and hospital stays in the NCRT group were significantly higher than those in the control group(P<0.05).The incidence of postoperative complications in the NCRT group was significantly higher than that in the control group(26.3% vs 13.4%,P<0.05).The NCRT group had lower postoperative adjuvant chemotherapy than the control group,with statistical differences significance(P<0.05).Comparison of prognostic data: The rate of 5-year LR was 4.1% and the rate of 5-year OS was 89.3% in the NCRT group.The rate of 5-year LR was 5.1% and the rate of 5-year OS was 89.8% in the control group.The difference was statistically significant(P<0.05).Conclutions: For patients with mid-low rectal cancer who have underwent MRI assessed T3N0 and absent mesocretal fasciainvasion(MRF-),the neoadjuvant chemoradiation can not reduce the rate of 5-year LR and increase the rate of 5-year OS.But it can reduce the tumor volume and reduce the pathological stage,and increase the rate of sphincter preservation and radical resection rate.Therefore,neoadjuvant chemoradiotherapy should be given to patients who require preservation of anal function.However,while bringing benefits,neoadjuvant chemoradiotherapy also make the operation more difficult,the incidence of perioperative and postoperative complications increased,increasing the patients physical and psychological trauma and medical burden.Therefore,we should based on the patient's specific conditions and wishes of the pursuit of personalized treatment,to avoid unnecessary over-treatment in clinical work.