Analysis of the safety and efficacy of 125I seed implantation in laparoscopic radical resection for rectal cancer

SHI Youquan; ZHOU Tingliang; YANG Xuliang; MENG Chuang; CAI Bin; ZHANG Yue

doi:10.3969/j.issn.1674-4136.2025.01.010

Abstract：Objective To investigate the safety and efficacy of combining radioactive 125I seed implantation with laparoscopic radical resection of rectal cancer,and to explore prevention and treatment strategies for postoperative complications.Methods A total of 122 patients who underwent laparoscopic radical resection of rectal cancer in the Gastrointestinal Surgery Department of Xuzhou Cancer Hospital from June 2019 to May 2021 were selected and divided into an implantation group(55 cases)and a non-implantation group(67 cases).Comparisons were made between the two groups regarding baseline characteristics,surgical outcomes,postoperative complications,as well as 3-year recurrence and survival rates.Results There were no statistically significant differences in baseline characteristics between the two groups(P＞0.05).The implantation group demonstrated significant increases in surgical duration,catheter removal time,and hospitalization costs compared to the non-implantation group(P＜0.05).There were no statistically significant differences observed in other surgical-related parameters,including surgical approach,prophylactic stoma creation,intraoperative blood loss,and hospital stay(P＞0.05).There were no significant differences between the two groups in terms of short-term postoperative complications(perineal incision infection,pelvic infection,anastomotic leakage,and major bleeding),some long-term postoperative complications(leukopenia,anastomotic stenosis,rectovaginal fistula,radiation enteritis,and particle migration),or overall postoperative complications(P＞0.05).However,the implant group had significantly higher incidences of urinary dysfunction(25.7％vs.12.6％)and fecal incontinence(25.5％vs.10.4％)compared to the non-implant group(P＜0.05).The implant group demonstrated a significantly lower postoperative tumor recurrence rate(3.6％vs.16.4％,P=0.036)and a significantly higher 3-year disease-free survival rate(95.9％vs.80.3％,P=0.018)compared to the non-implant group.Although the 3-year cumulative survival rate was higher in the implant group(87.9％)than in the non-implant group(79.9％),the difference did not reach statistical significance(P=0.261).Conclusions The combined treatment of laparoscopic radical resection for rectal cancer with radioactive 125I seed implantation,despite prolonging the operative time,increasing hospitalization costs,and potentially elevating the risks of urinary dysfunction and fecal incontinence,does not significantly increase the overall incidence of complications,and the associated complications can be effectively prevented and managed.More importantly,this combined therapeutic approach can effectively reduce the postoperative recurrence rate and improve the disease-free survival rate of patients,demonstrating ideal safety and efficacy.