Koea J B, Lanouette N, Paty P B, Guillem J G, Cohen A M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Dis Colon Rectum. 2000 May;43(5):628-32. doi: 10.1007/BF02235576.
Disease recurrence in the abdominal wall from a primary colorectal cancer is a poorly studied and little understood phenomenon that has received renewed attention after the recognition of port site metastases in patients after laparoscopic colorectal resections. The purpose of the present study was to define the clinical, pathologic, and management issues in patients with abdominal wall metastases from colorectal cancer.
Patients presenting to Memorial Sloan-Kettering Cancer Center with a diagnosis of colorectal cancer were entered into a prospective database beginning in 1986. Review of this database showed that 31 patients presenting with recurrent disease in the abdominal wall were managed surgically at the institution between 1986 and 1998.
A total of 31 patients (19 males) with a median age of 67 (range, 45-86) years presented with recurrent disease between 7 and 183 (median, 24) months after primary surgery. Primary tumors were located in the right colon in 17 patients, left colon in 2 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Nineteen percent of primary tumors were perforated, 45 percent were poorly differentiated, 92 percent were transmural (T3 or T4), and 51 percent had lymph node metastases at presentation. Twenty-two patients presented with a symptomatic abdominal wall mass, whereas recurrence in the abdominal wall was found incidentally in 9 patients undergoing laparotomy. Four patients had isolated abdominal wall disease, whereas the remaining 27 were found to have associated intra-abdominal disease. Six patients who were left with residual intra-abdominal cancer after abdominal wall resection had a median survival time of four months. Twenty-five patients underwent a histologically complete resection of recurrence restricted to the abdominal wall alone (n = 4; median survival time, 18 months), abdominal wall and in continuity resection of adherent viscera (n = 15; median survival time, 12.5 months), or resection of abdominal wall and intra-abdominal recurrence at a distant site (n = 6; median survival time, 22 months, although only 1 patient remained alive with disease). The actual two-year and five-year disease-free survival rates were 16 and 3 percent, respectively.
Abdominal wall metastases are often indicators of recurrent intra-abdominal cancer; however, aggressive resection in patients with disease restricted to the abdominal wall and associated adherent viscera can result in local disease control with little morbidity and no mortality.
原发性结直肠癌导致的腹壁疾病复发是一个研究较少且了解不多的现象，自腹腔镜结直肠癌切除术后患者出现切口部位转移被认识以来，该现象再次受到关注。本研究的目的是明确结直肠癌腹壁转移患者的临床、病理及治疗问题。
自1986年起，在纪念斯隆凯特琳癌症中心就诊且诊断为结直肠癌的患者被纳入前瞻性数据库。对该数据库的回顾显示，1986年至1998年间，该机构对31例出现腹壁复发性疾病的患者进行了手术治疗。
共有31例患者（19例男性），中位年龄67岁（范围45 - 86岁），在初次手术后7至183个月（中位时间24个月）出现复发性疾病。原发肿瘤位于右半结肠17例，左半结肠2例，乙状结肠7例，直肠3例。19%的原发肿瘤穿孔，45%分化差，92%为透壁性（T3或T4），51%在初诊时已有淋巴结转移。22例患者表现为有症状的腹壁肿块，而9例接受剖腹手术的患者腹壁复发是偶然发现的。4例患者仅有腹壁病变，其余27例发现有腹腔内相关病变。6例腹壁切除后腹腔内仍有残留癌的患者中位生存时间为4个月。25例患者接受了组织学上完整的复发灶切除，其中仅局限于腹壁的复发灶切除4例（中位生存时间18个月），腹壁及粘连脏器连续切除15例（中位生存时间12.5个月），或腹壁及远处腹腔内复发灶切除6例（中位生存时间22个月，尽管仅有1例患者带瘤存活）。实际的两年和五年无病生存率分别为16%和3%。
腹壁转移通常是腹腔内癌症复发的指标；然而，对病变局限于腹壁及相关粘连脏器的患者进行积极切除可实现局部疾病控制，且并发症少、无死亡。
