Gebhardt C, Meyer W, Ruckriegel S, Meier U
Department of Abdominal-, Thoracic- and Endocrine Surgery, Klinikum Nord, Nürnberg, Germany.
Langenbecks Arch Surg. 1999 Apr;384(2):194-9. doi: 10.1007/s004230050191.
In about 10% of patients with carcinoma of the colorectum, the tumour has already invaded contiguous organs or else inflammatory tumorous adhesions involving neighbouring structures are found. In such a situation, the question arises whether one should perform a multivisceral resection, the usefulness of which in terms of surgical risk and late oncological results have been investigated in the present study.
A total of 173 patients with colorectal carcinoma who underwent a multivisceral resection during the period between 1984 and 1995 are reported. Excluded from the study were patients with recurrent tumour or distant metastases.
In the majority of cases (63%), the primary tumour originated in the sigmoid colon or rectum. In 102 patients, only a single neighbouring organ was additionally involved, while the remaining patients had involvement of two or more contiguous organs. In 140 patients, the resection was curative, while in the remaining patients an R1/2 situation presented. In the curative group, tumour infiltration was confirmed histologically in 55% of the cases, while in the remaining patients a peritumourous adhesion had mimicked tumour invasion. Postoperative surgical complications occurred in only 1.4% of the interventions, a figure identical to the incidence of complications seen with conventional limited operations. The same applied to the postoperative 30-day mortality rate of 3.6%. The 5-year survival rate of the overall group of patients undergoing multivisceral resection was 42%, that of the subgroup undergoing curative surgery was 51%, and that of the subgroup receiving only palliative resection was 0%. Calculation of the stage-related 5-year survival rates for Union Internationale Contra la Cancrum stage-II and stage-III tumours revealed figures of 58% and 43%, respectively. After non-extended resection, the respective survival rates were identical (60% and 41%).
An identical surgical risk and survival rates for curative resection, equally as good as those seen with conventional, non-extended procedures, justify the liberal use of multivisceral resection in the surgical treatment of colorectal carcinomas directly invading neighbouring organs.
在约10%的结直肠癌患者中，肿瘤已侵犯相邻器官，或者发现存在累及邻近结构的炎性肿瘤粘连。在这种情况下，就产生了是否应进行多脏器切除术的问题，本研究已对其在手术风险和晚期肿瘤学结果方面的实用性进行了调查。
报告了1984年至1995年期间共173例行多脏器切除术的结直肠癌患者。复发性肿瘤或远处转移患者被排除在研究之外。
在大多数病例（63%）中，原发肿瘤起源于乙状结肠或直肠。102例患者仅额外累及一个相邻器官，而其余患者累及两个或更多相邻器官。140例患者的切除为根治性，而其余患者呈现R1/2情况。在根治性切除组中，55%的病例经组织学证实有肿瘤浸润，而其余患者的肿瘤周围粘连模拟了肿瘤侵犯。术后手术并发症仅发生在1.4%的手术中，这一数字与传统有限手术的并发症发生率相同。术后30天死亡率为3.6%时情况相同。接受多脏器切除术的全体患者的5年生存率为42%，接受根治性手术的亚组为51%，仅接受姑息性切除的亚组为0%。国际抗癌联盟II期和III期肿瘤的分期相关5年生存率计算结果分别为58%和43%。未进行扩大切除时，相应的生存率相同（60%和41%）。
根治性切除的手术风险和生存率与传统的非扩大手术相同，这证明在手术治疗直接侵犯相邻器官的结直肠癌时可广泛应用多脏器切除术。
