[The efficacy and safety of surgical treatment after neoadjuvant chemotherapy for cT4N+ colon cancer].

Objective: To evaluate the safety and efficacy of surgical treatment after neoadjuvant chemotherapy (NCT) for patients with cT4N+ colon cancer, and to explore whether the indication of NCT for colon cancer can be extended from cT4b to cT4N+ . Methods: The clinical data of 40 patients with cT4N+ colon cancer who underwent neoadjuvant chemotherapy followed by surgical treatment was retrospectively analyzed. The safety of neoadjuvant chemotherapy, surgical complications, R0 resection rate, tumor regression grade and prognosis were evaluated. Results: Of the 40 patients, 23 were male and 17 were female; the median age was 57 years old. All patients were well tolerated with chemotherapy, and only one case (1/40, 2.5%) had grade 3 chemotherapy-related adverse event. They all underwent surgery after chemotherapy, and 95.0% (38/40) achieved microscopically clear resection (R0). Of the 11 patients with cT4b, 54.5% (6/11) had undergone multivisceral resection (MVR). Postoperative pathological results showed that 12 patients had moderate to severe tumor regression, including one(1/40, 2.5%) achieved pathologic complete response (pCR). 29(72.5%) and 22 (55.0%) patients achieved down-staging of tumor T stage and N stage, respectively. The occurrence of surgical complications was 22.5% (9/40), including one case of anastomotic leakage (1/40, 2.5%). The 3-year disease-free survival and overall survival of the whole group were 75.0% and 80.0%, respectively. Conclusion: Surgery after neoadjuvant chemotherapy is safe and effective for patients with cT4N+ colon cancer, therefore indications for neoadjuvant chemotherapy for advanced colon cancer can be extended to cT4N+ stage.目的： 研究临床分期为cT4N＋期结肠癌患者新辅助化疗后外科治疗的效果和安全性，探讨进展期结肠癌新辅助化疗的指征能否从cT4b扩展至cT4N＋。 方法： 回顾性分析40例接受新辅助化疗后外科治疗的cT4N＋期结肠癌患者的临床病理资料，分析新辅助化疗的安全性、手术并发症、R0切除率、肿瘤退缩分级和患者的预后情况。 结果： 40例患者中，男23例，女17例；中位年龄57岁。40例患者均能良好地耐受化疗，仅1例(2.5%)患者出现3级化疗相关不良反应。所有患者化疗后均接受了手术治疗，R0切除率为95.0%(38/40)。11例cT4b期患者中，有6例患者接受了多脏器联合切除手术。术后病理结果显示，有12例患者存在中至重度肿瘤治疗退缩反应，其中1例(2.5%)患者达到病理完全缓解(pCR)。全组有29例(72.5%)患者实现肿瘤T分期的降期，有22例(55.0%)患者实现肿瘤N分期的降期。全组患者手术并发症的发生率为22.5%(9/40)，其中吻合口漏的发生率为2.5%(1/40)。全组患者的3年无病生存率和总生存率分别为75.0%和80.0%。 结论： 新辅助化疗后手术对于cT4N＋期结肠癌患者是安全有效的，进展期结肠癌新辅助化疗的指征可扩展至cT4N＋期结肠癌患者。.