Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi

Yıl 2021, Cilt: 8 Sayı: 2, 97 - 103, 31.08.2021

Muharrem Öztaş , İsmail Özerhan Armağan Günal Mehmet Beyzadeoğlu Yusuf Peker , Sadettin Çetiner

Öz

Bu çalışma, rektum kanserli hastalarda neoadjuvan kemoradyoterapinin (nKRT) evre gerilemesine ve sfinkter koruyucu cerrahiye olan etkisini ortaya koymak amacıyla yapılmıştır. Neoadjuvan kemoradyoterapi uygulanan distal rektum kanseri olan hastalar çalışmaya alınmıştır. Hastaların verileri retrospektif olarak taranarak özel olarak hazırlanmış veritabanına kaydedilmiştir. Hastalara uygulanan neoadjuvan tedavi protokolleri, neoadjuvan tedaviye bağlı tümör boyutunda küçülme ve evre gerilemesi oranları ile sfinkter koruyucu cerrahi (SKC) oranları belirlenerek literatür eşliğinde değerlendirme yapılmıştır. Alt ve orta rektum kanseri nedeniyle nKRT uygulanan 88 hasta çalışmaya alınmıştır. Hastaların yaş ortalaması 57.6 (21-78), kadın erkek oranı 3/5’di. Neoadjuvan tedavi sonrası ortalama bekleme süresi 6.5 (4-8) haftaydı. Downsizing, downstaging ve sfinkter korunma oranları sırasıyla %80.7, %65.9, %63.6 (alt rektum için %32.5, orta rektum için %89.6) olarak değerlendirildi. Neoadjuvan tedaviye bağlı dört hastada patolojik tam yanıt (pTY) alınmıştı. Hastalardan 47’sine aşağı anterior rezeksiyon, sekizine çok aşağı anterior rezeksiyon ve bir hastaya intersfinkterik rezeksiyon uygulanmıştı. SKC uygulanan 5 hastada ileri derecede inkontinans olduğu (wexner skoru ≥ 9) ve genel olarak hastalarının yaşam kalitesinin bozulmadığı değerlendirildi. Sonuç olarak neoadjuvan tedavi sonrası ‘’downsizing’’ ’’downstaging’’ oranları ve SKC oranlarının literatürle uyumlu olduğu değerlendirildi. Yine literatürde de belirtildiği gibi SKC oranları üzerindeki en etkili faktörler; tümörün seviyesi, anal sfinkter mekanizması ile ilişkisi ve cerrahın tutumu olarak değerlendirildi.

Anahtar Kelimeler

Neoadjuvan Tedavi, Sfinkter Koruyucu Cerrahi, Rektum Kanseri

Neoadjuvant Chemoradiotherapy and The Sphinchter Sparing Surgery Association in Rectal Cancer

Öz

This study was conducted to reveal the effect of neoadjuant chemoradiotherapy to down-staging and sphincter sparing surgery in rectal cancer. Patients with lower and middle rectum cancer undergoing neoadjuvant chemoradiotherapy were included in the study. The data of the patients were collected retrospectively and recorded in a database. Neoadjuvant treatment protocols applied to the patients, downsizing, downstagings and sphincter sparing surgery rates were determined and evaluation was made in the light of the literature. 88 patients who received neoadjuvant chemoradiotherapy for lower and middle rectal cancer were included in the study. The mean age of the patients was 57.6 (21-78) years, and the ratio of women to men was 3/5. The mean waiting time after neoadjuvant therapy was 6.5 (4-8) weeks. Downsizing, downstaging and sphincter sparing rates were 80.7%, 65.9%, 63.6% (32.5% for the lower rectum, 89.6% for the middle rectum) respectively. The pathological complete response was obtained in four patients. Eight of the patients had undergone very low anterior anterior resection, 47 had low anterior resection and 1 patient had intersphincteric resection. It was evaluated that, 5 patients who underwent sphincter sparing surgery had advanced incontinence score (wexner≥9) and their quality of life was generally not impaired. As a result, the rates of downsizing, downstaging and sphincter-sparing surgery rates after neoadjuvant therapy were evaluated to be compatible with the literature. As stated in the literature, the most effective factors on sphincter sparing surgery rates are; the location of the tumor, its relation with the anal sphincter mechanism and the surgeon's attitude.

Anahtar Kelimeler

Neoadjuvan Treatment, Sphincter Sparing Surgery, Rectal Cancer

Kaynakça

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