Background:Adjuvant therapies improve disease-free and cancer-specific survival in digestive tract malignancies. Return to intended oncological therapy (RIOT) measures how promptly patients resume these treatments after cancer resection. Because sugammadex has demonstrated superior postoperative outcomes compared to neostigmine, we hypothesize that its use may increase the likelihood and timeliness of RIOT in patients undergoing digestive tract cancer surgery.Methods:Adults (≥18 years) undergoing gastrointestinal, hepatobiliary cancer resection, or liver resection for limited metastases between January 2016 and December 2017 were retrospectively analyzed. Patients were grouped by neuromuscular blockade reversal agent (neostigmine vs. sugammadex). The primary outcome was RIOT within 90 days; secondary outcomes included RIOT within 180 days, time-to-RIOT, hospital length of stay, ICU admission, and readmissions.Results:Of 4358 records screened, 1081 met the inclusion criteria: 273 (25.2%) patients with neostigmine and 808 (74.8%) with sugammadex. Patients in the neostigmine group were slightly younger, and racial distribution differed modestly, but sex, BMI, ASA class, comorbidity, cancer type, and stage were comparable. Median reversal doses were 5 mg and 200 mg, respectively. Anesthesia duration, hospital and ICU length of stay, readmissions, and ICU use showed no significant differences. RIOT frequency was also similar across groups, except for modestly higher radiotherapy resumption with neostigmine at 90 and 180 days. Overall, perioperative and oncological outcomes were largely comparable between groups.Conclusions:Sugammadex and neostigmine showed similar RIOT rates, with only a modest difference in radiotherapy resumption. Larger studies are needed to elucidate the potential benefits of sugammadex, particularly regarding long-term oncological outcomes and treatment continuity.
背景：辅助治疗可改善消化道恶性肿瘤患者的无病生存期和癌症特异性生存期。重返预定肿瘤治疗（RIOT）衡量患者癌症切除后恢复这些治疗的及时性。由于舒更葡糖相比新斯的明已展现出更优的术后恢复效果，我们假设其在消化道癌症手术患者中的应用可能提高RIOT的实现可能性和及时性。 方法：回顾性分析2016年1月至2017年12月期间接受胃肠道癌切除、肝胆管癌切除或局限性转移灶肝切除术的成年患者（≥18岁）。根据神经肌肉阻滞逆转剂使用情况分组（新斯的明组 vs 舒更葡糖组）。主要结局指标为90天内实现RIOT；次要结局包括180天内实现RIOT、达到RIOT的时间、住院时长、ICU入住率及再入院率。 结果：在筛查的4358份记录中，1081例符合纳入标准：新斯的明组273例（25.2%），舒更葡糖组808例（74.8%）。新斯的明组患者年龄略轻，种族分布存在细微差异，但性别、BMI、ASA分级、合并症、癌症类型及分期具有可比性。中位逆转剂量分别为5 mg和200 mg。麻醉时长、住院及ICU时长、再入院率及ICU使用率均无显著差异。除新斯的明组在90天和180天的放疗恢复率略高外，各组的RIOT实现频率基本相似。总体而言，两组围手术期及肿瘤学结局基本相当。 结论：舒更葡糖与新斯的明在RIOT实现率方面表现相似，仅在放疗恢复方面存在细微差异。需要更大规模研究以阐明舒更葡糖的潜在获益，特别是在长期肿瘤学结局和治疗连续性方面。
肿瘤(癌症)患者之家