Blair S, Ellenhorn J D
Department of Surgery, City of Hope Medical Center, Duarte, California 91010, USA.
Am Surg. 2000 Sep;66(9):817-20.
Controversy still exists as to the optimal treatment of early-stage low rectal cancers. Standard resections such as abdominal perineal resections or low anterior resection with coloanal anastomosis can be associated with significant morbidity. Local excision has been considered as a potentially far less morbid option for these patients. We identified 20 patients from our prospective tumor registry database that underwent transanal resection of early rectal cancers between 1988 and 1998. Five patients had carcinoma in situ, and 15 patients had T1 lesions. All T1 lesions were well or moderately well differentiated, and none had lymphovascular invasion. The mean tumor size was 2.65 cm, and the average distance from the anal verge was 4.55 cm. One patient required temporary colostomy because of postoperative complications. Four patients had postoperative adjuvant therapy (radiation alone, two; radiation and chemotherapy, two) for close margins after they refused an abdominal perineal resection. With a median follow-up of 60 months there were no recurrences and no cancer-related deaths. This series suggests that transanal excision is a safe and effective treatment for selected early low rectal cancers with favorable histology.
对于早期低位直肠癌的最佳治疗方法仍存在争议。标准切除术，如腹会阴联合切除术或低位前切除术加结肠肛管吻合术，可能会带来显著的发病率。局部切除术被认为是这些患者潜在的发病率低得多的选择。我们从我们的前瞻性肿瘤登记数据库中识别出20例在1988年至1998年间接受早期直肠癌经肛门切除术的患者。5例为原位癌，15例为T1期病变。所有T1期病变均为高分化或中分化，且均无淋巴管浸润。肿瘤平均大小为2.65 cm，距肛缘平均距离为4.55 cm。1例患者因术后并发症需要临时结肠造口术。4例患者因切缘阳性拒绝腹会阴联合切除术后接受了术后辅助治疗（单纯放疗2例；放疗加化疗2例）。中位随访60个月，无复发及癌症相关死亡。该系列研究表明，经肛门切除术是治疗部分组织学特征良好的早期低位直肠癌的一种安全有效的方法。
