Background: The treatment of locally advanced rectal cancer (LARC) has steadily progressed over the past four decades, with recent focus shifting towards total neoadjuvant therapy (TNT). This survey aims to elucidate the perceived surgical challenges faced by Austrian colorectal surgeons performing total mesorectal excision (TME), focusing on the increased complexity and surgical difficulty introduced by intensified treatment regimens. Methods: A comprehensive survey was conducted among Austrian colorectal surgeons to explore various aspects of managing and performing TME following TNT. The survey included questions on the general management of LARC within their institutions and utilized a five-point Likert scale to assess the respondents’ perceptions and experiences regarding surgical precision and post-operative morbidity associated with TNT. Results: A total of 31 surgeons (54% response rate) completed the survey. Regarding multidisciplinary therapy preferences, 56% of respondents preferred conventional neoadjuvant therapy regimens, with 32% favoring chemoradiotherapy and 24% opting for short-course radiotherapy, while 31% chose TNT. The majority of respondents (65%) reported quality differences in tissue dissection during TME following TNT, with 57% experiencing difficulties in identifying tissue planes and 47% noting increased tissue fragility. Increased bleeding was reported by 32% of respondents. In cases of regrowth after a watch-and-wait approach, 64% observed quality changes in tissue dissection, and 47% noted tissue fragility. Conclusions: The survey results indicate that TNT impairs surgical precision due to changes in tissue quality and challenges in identifying surgical planes. Given the critical importance of surgical precision in achieving low local recurrence rates in mid-to-low LARC, these challenges could significantly impact patient outcomes. Further prospective studies are required to elucidate the extent of these effects.
背景：过去四十年来，局部进展期直肠癌的治疗稳步发展，近期研究重点已转向全新辅助治疗。本研究旨在阐明奥地利结直肠外科医生在全直肠系膜切除术中面临的手术挑战，重点关注强化治疗方案带来的手术复杂性及难度增加。方法：对奥地利结直肠外科医生开展综合问卷调查，探究全新辅助治疗后实施全直肠系膜切除术的各方面管理情况。问卷内容涵盖所在机构对局部进展期直肠癌的常规管理方案，并采用李克特五分量表评估受访者对全新辅助治疗相关手术精准度及术后并发症的认知与经验。结果：共31位外科医生完成问卷（回复率54%）。关于多学科治疗方案偏好，56%受访者倾向传统新辅助治疗方案，其中32%选择放化疗，24%选择短程放疗，另有31%选择全新辅助治疗。多数受访者（65%）报告全新辅助治疗后实施全直肠系膜切除术时存在组织解剖质量差异，57%遇到组织层面辨识困难，47%发现组织脆性增加。32%受访者报告出血量增多。在等待观察后出现再生长病例中，64%观察到组织解剖质量改变，47%发现组织脆性增加。结论：调查结果表明，全新辅助治疗会因组织质量改变及手术层面辨识困难而影响手术精准度。鉴于手术精准度对中低位局部进展期直肠癌实现低局部复发率至关重要，这些挑战可能显著影响患者预后。需开展进一步前瞻性研究以明确这些影响的程度。
肿瘤(癌症)患者之家