Ann Surg Oncol：直肠癌术前放(化)疗可损伤患者肛肠功能

　　术前放(化)疗(pR(C)T)可显著降低患者局部复发风险，因而被推荐用于II/II期直肠癌患者。然而，这类多模式治疗方法可能与后期不良事件存在关联。为了确定pR(C)T对肛肠功能、性功能以及排尿功能的长期影响，德国慕尼黑工业大学的Martin Loos博士等人进行了一项系统性考察与荟萃分析。该文发表于2012年12月27日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

　　研究人员通过PubMed、Embase以及Cochrane图书馆，系统性搜索了对接受术前放(化)疗及直肠癌切除术后，患者长期机体功能预后方面进行报道的相关研究文献。该研究合格入选研究类型为，针对通过TME(全直肠系膜切除术)技术结合直肠癌切除术前放(化)疗后，在患者肛肠功能、性功能以及/或排尿功能方面进行报道的相关研究文献。

　　研究人员最终共甄别出25项研究，涉及6,548例患者。他们发现，合格研究的方法学质量较低。大多数研究报道称，术前放(化)疗后，患者肛肠功能(14/18项研究)以及男性患者的性功能(9/10项研究)出现障碍。少数研究对女性患者的性功能障碍情况进行了考察(n = 4)。荟萃分析表明，放疗患者更易出现大便失禁情况(风险比 (RR) = 1.67; 95 %置信区间(CI), 1.36, 2.05; p<0.0001)，此外，术前放(化)疗后，患者的测压结果 (平均静息压力(加权平均差(WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04)以及最大收缩压力结果(WMD = 30.39; 95 % CI, 21.48, 39.3; p<0.0001))明显较差。荟萃分析也表明，在患者勃起障碍方面并不存在统计学意义上的显著性差异(RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3)。8项研究中的6项研究，以及荟萃分析都表明，术前放(化)疗对患者排尿功能无副作用(RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82)。

　　Martin Loos博士等人据此认为，尽管患者功能长期预后方面研究的质量较为有限，但现有证据足以证明，术前放(化)疗后进行TME可对患者肛肠功能产生负面影响。　

Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis

Background

Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis.

Methods

PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion.

Results

Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65;p = 0.82).

Conclusions

Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.