Heintz A, Mörschel M, Junginger T
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität Mainz.
Zentralbl Chir. 1999;124(5):436-40.
The results of local excision and radical surgery in patients with T1-carcinomas of the rectum were compared. In a retrospective study (1.1.1985-1.7.1997) the results obtained in 107 patients with T1-rectal carcinoma ("low risk" T1: n = 83, "high risk" T1: n = 24) undergoing local excision or radical surgical therapy were compared. The complication rate in patients undergoing local excision was 3.3% (2/60) and ranged at 19% (9/47) in the group treated with radical surgery. Two out of 47 patients (4.2%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, in the group with "low risk" T1 carcinoma no difference was observed between patients treated with local excision (79%) or radical resection (81%) (p = 0.72). In patients with "high risk" T1 carcinoma lymph node metastases were identified in 4 out of 11 patients undergoing radical resection (36%). 4 out of 13 patients with "high risk" T1 carcinoma treated by local excision developed recurrences, while none of the patients undergoing primary radical surgery had a recurrence. This underlines the necessity of radical surgery in "high risk" T1-carcinomas. Local excision for the treatment of "low risk" T1-carcinoma is associated with a significantly lower complication rate than the performance of a radical surgical therapy. There is no difference in five-year-survival between local and radical surgical therapy in patients with "low risk" T1 carcinoma.
对直肠T1期癌患者的局部切除和根治性手术结果进行了比较。在一项回顾性研究（1985年1月1日至1997年7月1日）中，比较了107例接受局部切除或根治性手术治疗的T1期直肠癌患者（“低风险”T1：n = 83，“高风险”T1：n = 24）的治疗结果。接受局部切除患者的并发症发生率为3.3%（2/60），而根治性手术治疗组的并发症发生率为19%（9/47）。47例接受根治性切除的患者中有2例（4.2%）死亡；局部切除后无死亡病例。关于精算5年生存率，在“低风险”T1期癌组中，接受局部切除（79%）或根治性切除（81%）的患者之间未观察到差异（p = 0.72）。在“高风险”T1期癌患者中，11例接受根治性切除的患者中有4例（36%）发现有淋巴结转移。13例接受局部切除治疗的“高风险”T1期癌患者中有4例出现复发，而接受初次根治性手术的患者均无复发。这强调了对“高风险”T1期癌进行根治性手术的必要性。与根治性手术治疗相比，“低风险”T1期癌的局部切除治疗并发症发生率显著更低。“低风险”T1期癌患者的局部手术和根治性手术治疗的五年生存率无差异。
