Clinical Analysis Of Surgical Treatment Of Locally Recurrent Rectal Cancer

Objective: Accurately assess the stage of patients before surgery,select appropriate patients for surgery,increase the R0 resection rate,and then improve the surgical efficacy of LRRC patients.Methods: The data of 56 patients with LRRC who were re-operated in the Department of General Surgery of the First Affiliated Hospital of Nanchang University from January 2009 to May 2016 were collected.Analyze the 5-year survival rate of 56 patients by statistical methods and use the KM curve to plot their overall survival time,analyze the differences in the efficacy of patients under different recurrence modes.Univariate and multivariate COX regression analysis was used to evaluate the relationship between clinical factors and long-term prognosis,and logistic multiple regression analysis was used to analyze the related risk factors that affect R0 resection.Results: The average overall survival time of 56 patients was 38.9 months(median survival time was 32.5 months,the range was 5-74 months),and the 1,3,and5-year survival rates were 92.9%,46.4%,and 35.7%,respectively.Compared with nonaxial recurrence,the operation time for axial recurrence is longer(338.6±91.4 VS219.6±47.0min,P=0.001),and the intraoperative blood loss is more(1381.8±187.2ml VS 345.8±363.8ml,P= 0.045),the tumor is more difficult to completely remove(P=0.005),and the preoperative serum CEA is more likely to increase(P=0.005).Univariate analysis showed that patients with normal serum CEA before LRRC,negative margins during surgery,no complications after surgery,and earlier postoperative pathological staging are more likely to achieve long-term survival(overall survival time ≥ 5 years),P Value <0.05;patients with normal preoperative serum CEA,axial recurrence,and earlier postoperative pathological staging are more likely to achieve R0(P<0.05).Multivariate analysis showed that R0 resection was an independent factor affecting long-term survival.Conclusion: Accurately assessing the stage and type of recurrence of patients before surgery,and selecting appropriate patients for surgery can increase the R0 resection rate and thereby improve the surgical efficacy of LRRC patients.