Rektum kanserlerinde neoadjuvan ve adjuvan tedavinin anastomoz kaçakları ve morbidite üzerine etkisinin karşılaştırılması
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Rektum kanseri tanısıyla ameliyat edilen hastalarda, neoadjuvan ve adjuvan tedavinin anastamoz kaçakları ve mortalite üzerine etkilerini araştırmayı amaçladık. Çalışmaya 2010-2019 yılları arasında 18 yaşından büyük ve rektum kanseri tanısı almış ve kliniğimizde cerrahi operasyon geçiren, radyasyon onkolojisi ve medikal onkoloji klinikleri tarafından adjuvan ve neoadjuvan tedavi uygulanan hastalar dahil edildi. Abdominopelvik rezeksiyon yapılan hastalar ve acil ameliyat edilen hastalar çalışmaya dahil edilmedi. Sadece taburculuğa kadar ortaya çıkan anastomoz kaçakları çalışmaya dahil edildi. Hasta verilerine merkezi arşivden ve onkoloji kliniklerinin arşivlerinden ulaşıldı. Çalışmaya katılan hastaların demografik verileri, tümör evrelemesi, metastaz durumu, organ ve lenf nodu tutulumları, cerrahi tipi, aldıkları adjuvan ve neoadjuvan tedaviler, anastomoz kaçağı varlığı, mortalitesi ve serum karsinoembriyonik antijen düzeyleri hasta dosyalarından kayıt edildi. Çalışmaya 179'u (%56,1) erken, 140'ı (%43,9) kadın 319 hasta dahil edildi. Hastaların yaş ortalaması 58,6±13,21 yıl idi. Çalışmaya dahil edilen hastaların % 48,6'sının (n=155) adjuvan, %51,4'ünün (n=164) ise neoadjuvan tedavi aldığı saptandı. Hastaların %89,3'ünün (n=285) aldığı, %86,8'inin (n=277) i aldığı, %76,1'inin (n=243) ise hem radyoterapi hem de kemoterapi aldığı bulundu. Çalışmaya katılan hastaların %23,5'inde (n=75) anastomoz kaçağı tespit edildi. Adjuvan ve neoadjuvan tedavi alan hastalar arasında anastomoz kaçağı sıklığı açısından fark görülmedi (p=0,758). Radyoterapi ve kemoterapinin anastomoz kaçağı üzerine etkisi olup olmadığını araştırmak için neoadjuvan tedavi alan 164 hastamız içinde ve adjuvan tedavi alan 155 hastamız içinde radyoterapi ve kemoterapi alan hastalar ile bunlardan birini alan hastalar arasında anastomoz kaçağı gelişimi açısından fark olup olmadığı araştırılmıştır ve fark bulunmamıştır (sırasıyla p=0,827 ve p=0,1). Anastomoz kaçağı olan hastalarda mortalitenin artmadığı görüldü. N2 lenf nodu tutulumu olan hastalarda Anastomoz kaçağı daha sık görüldü (p=0,021). Anastomoz kaçağı görülen hastalar daha zayıftı (75,33±13,44 vs. 71,88±14,23 kg, p=0,042). Preoperatif serum karsinoembriyonik antijen düzeyi >10 ng/ml olan hastalarda mortalite daha yüksekti (p=0,045). Serum karsinoembriyonik antijen düzeylerinin postoperatif dönemde anlamlı düzeyde düştüğü görüldü (p<0,001). Neoadjuvan ve adjuvan tedavi alan hastalar arasında anastomoz kaçağı gelişimi açısından fark bulunmamaktadır. Neoadjuvan ve adjuvan olarak radyoterapi ve kemoterapiden herhangi birinin kullanımı ve her iki tedavinin birlikte kullanımı anastomoz kaçağı riskini artırmamaktadır. Anastomoz kaçağı olan hastalarda mortalite artmamaktadır. Daha iyi lokal kontrol, genel sağkalım ve sfinkter fonksiyonu koruma oranları nedeniyle rektum kanseri tedavisinde bu tedavilerden vazgeçilmemelidir. Anahtar kelimeler: Rektum kanseri, radyoterapi, kemoterapi, anastamoz kaçağı
In our study, we aimed to investigate the effects of neoadjuvant and adjuvant therapies on the anastomotic leakage and morbidity in patients who underwent surgery due to rectum cancer. Patients who were older than 18 years of age, were diagnosed as having rectum cancer, underwent surgical operation in our clinic between 2010-2019 and were treated with adjuvant and/or neoadjuvant treatment administered by radiation oncology and medical oncology clinics, were included in this study. The data of the patients were obtained from the central archive and the archives of the oncology clinic. Patients who underwent abdominopelvic resection and patients who underwent emergency surgery were not included in the study. Only the anastomotic leakages which had appeared until the discharge were included in the study. Demographic data, tumor staging, presence of metastasis, organ and lymph node involvement, type of surgery, adjuvant and/or neoadjuvant treatments, presence of anastomotic leakage, mortality and serum carcinoembryonic antigen levels were recorded from the patients' files. Tree hundred nineteen patients were included in the study, of whom 179 (56.1%) were male and 140 (43.9%) were female. The mean age of the patients was 58.6±13.21 years. Of the patients included in the study, 48.6% (n=155) received adjuvant therapy and 51.4% (n=164) received neoadjuvant therapy. It was found that 89.3% (n=285) of the patients received radiotherapy, 86.8% (n=277) received chemotherapy, and 76.1% (n=243) received both radiotherapy and chemotherapy. Anastomotic leakage was detected in 23.5% (n=75) of the patients participating in the study. There was no difference in terms of anastomotic leakage frequency between the patients receiving adjuvant and neoadjuvant therapy (p=0.758). To investigate whether radiotherapy or chemotherapy had an effect on anastomotic leakage, we investigated whether there was a difference in terms of anastomotic leakage development between the patients receiving radiotherapy or chemotherapy alone or both radiotherapy and chemotherapy as adjuvant treatment in 155 patients and as neoadjuvant treatment in 164 patients and did not find any difference (p=0.827 and p=0,1, respectively). Mortality did not increase in patients with anastomotic leakage. Anastomotic leakage was more common in patients with N2 lymph node involvement (p=0,021). Patients with anastomotic leakage were more lightweighted (75,33±13,44 vs. 71.88±14.23 kg, p=0.042). Mortality was higher in patients with preoperative serum carcinoembriyonic antigen level >10 ng/ml (p=0.045). Serum carcinoembriyonic antigen levels decreased significantly during the postoperative period (p<0.001). There was no difference between neoadjuvant and adjuvant therapies in terms of the development of anastomotic leakage. The use of any of radiotherapy and chemotherapy as neoadjuvant or adjuvant therapy and the combined use of both radiotherapy and chemotherapy did not increase the risk of anastomotic leakage. Mortality did not increase in patients with anastomotic leakage. Because of better local control, overall survival and sphincter function preservation rates, these treatments should not be abandoned in the treatment of rectum cancer. Keywords: Rectum cancer, radiotherapy, chemotherapy, anastomotic leakage
In our study, we aimed to investigate the effects of neoadjuvant and adjuvant therapies on the anastomotic leakage and morbidity in patients who underwent surgery due to rectum cancer. Patients who were older than 18 years of age, were diagnosed as having rectum cancer, underwent surgical operation in our clinic between 2010-2019 and were treated with adjuvant and/or neoadjuvant treatment administered by radiation oncology and medical oncology clinics, were included in this study. The data of the patients were obtained from the central archive and the archives of the oncology clinic. Patients who underwent abdominopelvic resection and patients who underwent emergency surgery were not included in the study. Only the anastomotic leakages which had appeared until the discharge were included in the study. Demographic data, tumor staging, presence of metastasis, organ and lymph node involvement, type of surgery, adjuvant and/or neoadjuvant treatments, presence of anastomotic leakage, mortality and serum carcinoembryonic antigen levels were recorded from the patients' files. Tree hundred nineteen patients were included in the study, of whom 179 (56.1%) were male and 140 (43.9%) were female. The mean age of the patients was 58.6±13.21 years. Of the patients included in the study, 48.6% (n=155) received adjuvant therapy and 51.4% (n=164) received neoadjuvant therapy. It was found that 89.3% (n=285) of the patients received radiotherapy, 86.8% (n=277) received chemotherapy, and 76.1% (n=243) received both radiotherapy and chemotherapy. Anastomotic leakage was detected in 23.5% (n=75) of the patients participating in the study. There was no difference in terms of anastomotic leakage frequency between the patients receiving adjuvant and neoadjuvant therapy (p=0.758). To investigate whether radiotherapy or chemotherapy had an effect on anastomotic leakage, we investigated whether there was a difference in terms of anastomotic leakage development between the patients receiving radiotherapy or chemotherapy alone or both radiotherapy and chemotherapy as adjuvant treatment in 155 patients and as neoadjuvant treatment in 164 patients and did not find any difference (p=0.827 and p=0,1, respectively). Mortality did not increase in patients with anastomotic leakage. Anastomotic leakage was more common in patients with N2 lymph node involvement (p=0,021). Patients with anastomotic leakage were more lightweighted (75,33±13,44 vs. 71.88±14.23 kg, p=0.042). Mortality was higher in patients with preoperative serum carcinoembriyonic antigen level >10 ng/ml (p=0.045). Serum carcinoembriyonic antigen levels decreased significantly during the postoperative period (p<0.001). There was no difference between neoadjuvant and adjuvant therapies in terms of the development of anastomotic leakage. The use of any of radiotherapy and chemotherapy as neoadjuvant or adjuvant therapy and the combined use of both radiotherapy and chemotherapy did not increase the risk of anastomotic leakage. Mortality did not increase in patients with anastomotic leakage. Because of better local control, overall survival and sphincter function preservation rates, these treatments should not be abandoned in the treatment of rectum cancer. Keywords: Rectum cancer, radiotherapy, chemotherapy, anastomotic leakage
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Genel Cerrahi, General Surgery
