Jatzko G R, Jagoditsch M, Lisborg P H, Denk H, Klimpfinger M, Stettner H M
Hospital of Barmherzige Brüder St. Veit/Glan, University of Vienna, Austria.
Eur J Surg Oncol. 1999 Jun;25(3):284-91. doi: 10.1053/ejso.1998.0643.
To evaluate consistent radical surgery performed over a 13-year period for rectal cancer in terms of local tumour control and long-term survival.
Radical surgical procedure principally using total mesorectal excision (TME) for middle and lower rectal tumours, high ligation of the inferior mesenteric artery and sphincter-saving resections (SSR) whenever possible, has been performed prospectively since January 1984.
Tumour resection was possible in 98.8% (636/644), potentially curative resections (UICC/AJCC R0 resection) in 85.7% (552/644) and sphincter preservation in 71.7% (462/644). Five- and 10-year observed survival rates, surgical mortality not excluded, for all patients were 49.2% and 37.4%. Tumour-adjusted 5- and 10-year survival rates were 60.5% and 55.3%. For curatively operated patients (UICC/AJCC R0) 5- and 10-year observed survival rates were 56.3% and 42.6% and tumour-adjusted survival rates were 68.6% and 62.7%. The 5- and 10-year local recurrence rates for R0 resected patients were 12.0% and 12.6%. Post-operative hospital mortality was 3.1%.
Multivariate analysis using Cox's model identified increasing pT category and pN category, old age and low tumour location as detrimental factors having independent influence on survival. For local tumour failure only pT and pN category as well as adjuvant radiation therapy were identified in the Cox model as having an independent detrimental influence.
从局部肿瘤控制和长期生存方面评估13年间对直肠癌实施的一致性根治性手术。
自1984年1月起前瞻性地开展根治性手术，主要对中低位直肠肿瘤采用全直肠系膜切除术（TME），尽可能行肠系膜下动脉高位结扎和保肛手术（SSR）。
98.8%（636/644）的患者可行肿瘤切除，85.7%（552/644）的患者可行潜在根治性切除（UICC/AJCC R0切除），71.7%（462/644）的患者可保留括约肌。所有患者未排除手术死亡率的5年和10年观察生存率分别为49.2%和37.4%。肿瘤校正后的5年和10年生存率分别为60.5%和55.3%。接受根治性手术的患者（UICC/AJCC R0）的5年和10年观察生存率分别为56.3%和42.6%，肿瘤校正后的生存率分别为68.6%和62.7%。R0切除患者的5年和10年局部复发率分别为12.0%和12.6%。术后医院死亡率为3.1%。
使用Cox模型进行的多变量分析确定，pT分期增加、pN分期增加、老年和肿瘤位置低是对生存有独立影响的不利因素。在Cox模型中，对于局部肿瘤失败，仅确定pT和pN分期以及辅助放疗具有独立的不利影响。
