Nyam D C, Ho Y H, Leong A F, Seow-Choen F
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Singapore Med J. 1999 May;40(5):333-5.
Recurrent colorectal cancer carries a poor prognosis. Radical re-resection is the only chance for long-term survival but suitable candidates are few.
To determine the patterns of recurrence after potentially curative colorectal surgery and analyse the results of palliative surgery for patients with local recurrence.
Between May 1989 and May 1995, 1,287 case records of patients with colorectal carcinoma were entered into a customized computer database. Of these, 1,103 underwent potentially curative resections (Duke's stage A, B and C). At a median of 40 months (range 2-72) following surgery, 173 patients had recurrent disease detected (98 males; 75 females) at a median of 14 months (range 3-30) after the index surgery. Twelve percent had recurrent distal and locoregional disease while 6.8% had locoregional recurrent disease alone. Thirty-seven patients with locally recurrent disease underwent surgery. Of these, only 7 patients with local recurrences were suitable candidates for resections. The remaining 30 underwent palliative surgery for emergent indications of obstruction (28) and bleeding (2). The symptoms were palliated surgically by an entero-enterostomy (13), defunctioning stoma (12), lysis of adhesions (1), exploratory celiotomy (2) and formalin application (2). Seventeen patients are alive at follow-up. Twenty patients died at a median of 4 months after surgery (range 1-15). All patients had palliation of their symptoms.
Low incidences of local recurrences can be achieved after potentially curative resections for colorectal carcinoma. When recurrences occur, a small number can be salvaged with a re-resection which is the procedure of choice. Palliative procedures for emergent indications of obstruction and bleeding can give good palliation despite the absence of the possibility of cure.
复发性结直肠癌预后较差。根治性再次手术是长期生存的唯一机会，但合适的患者很少。
确定结直肠癌根治性手术后的复发模式，并分析局部复发患者的姑息性手术结果。
1989年5月至1995年5月，1287例结直肠癌患者的病例记录被录入定制的计算机数据库。其中，1103例行根治性切除术（杜克分期A、B和C）。术后中位时间40个月（范围2 - 72个月），173例患者复发疾病被检测到（98例男性；75例女性），复发中位时间为初次手术后14个月（范围3 - 30个月）。12%有远端和局部区域复发疾病，而6.8%仅有局部区域复发疾病。37例局部复发患者接受了手术。其中，只有7例局部复发患者适合再次切除。其余30例因肠梗阻（28例）和出血（2例）等紧急指征接受了姑息性手术。通过肠吻合术（13例）、造瘘术（12例）、粘连松解术（1例）、剖腹探查术（2例）和应用福尔马林（2例）进行手术姑息治疗。17例患者随访时存活。20例患者术后中位4个月死亡（范围1 - 15个月）。所有患者症状均得到缓解。
结直肠癌根治性切除术后局部复发率较低。复发时，少数患者可通过再次切除挽救，再次切除是首选方法。尽管无法治愈，但针对肠梗阻和出血等紧急指征的姑息性手术可有效缓解症状。
