Jagoditsch M, Lisborg P H, Jatzko G R, Wette V, Kropfitsch G, Denk H, Klimpfinger M, Stettner H M
Department of Surgery, Hospital of the Barmherzige Brueder St. Veit/Glan Teaching Hospital, Faculty of Medicine, University of Vienna, Austria.
World J Surg. 2000 Oct;24(10):1264-70. doi: 10.1007/s002680010252.
Despite the improvement in its prognosis in most Western countries, death from colon cancer is still a major problem. In a prospectively planned observation study, a large patient collective from a single institution in Austria was analyzed in terms of the surgical approach and factors influencing survival. A total of 696 patients with colonic carcinomas were admitted to our surgical department between January 1, 1984 and December 31, 1997. Radical surgery for localized tumors was consistently performed, including wide resection margins and complete removal of the regional lymph drainage zones. Clinical, histopathologic, and therapy-related factors were examined for their influence on long-term survival by means of univariate and multivariate analysis. The overall tumor resection rate was 99.3% (691/696); complete tumor removal (R0) was possible for 84.8% (590/696) of all patients. The overall postoperative hospital mortality rate was 3.2% (22/696), and it was 13% (7/556) for potentially curative resections. Five- and ten-year tumor-specific survival rates for stage I to III R0 resections were 83.8% and 78.8%, respectively. Adjuvant chemotherapy reduced tumor recurrence for stage III patients by 52.4%. The depth of tumor infiltration, lymph node status, and adjuvant chemotherapy were found to have an independent influence on survival as identified by the Cox models. In conclusion, a consistent radical surgical approach for potentially curative resected colonic cancer patients had survival rates that surpassed those of most published series without sacrificing low complication rates. In addition, adjuvant chemotherapy for stage III substantially improved survival.
尽管在大多数西方国家结肠癌的预后有所改善，但结肠癌导致的死亡仍然是一个主要问题。在一项前瞻性规划的观察性研究中，对来自奥地利一家单一机构的大量患者群体进行了手术方式及影响生存因素的分析。1984年1月1日至1997年12月31日期间，共有696例结肠癌患者入住我们的外科科室。对于局限性肿瘤始终实施根治性手术，包括广泛的切缘和区域淋巴引流区的完整切除。通过单因素和多因素分析检查临床、组织病理学和治疗相关因素对长期生存的影响。总体肿瘤切除率为99.3%（691/696）；84.8%（590/696）的患者能够实现肿瘤完整切除（R0）。术后总体医院死亡率为3.2%（22/696），潜在根治性切除患者的死亡率为13%（7/556）。I至III期R0切除的5年和10年肿瘤特异性生存率分别为83.8%和78.8%。辅助化疗使III期患者的肿瘤复发率降低了52.4%。如Cox模型所示，肿瘤浸润深度、淋巴结状态和辅助化疗对生存有独立影响。总之，对于潜在可根治性切除的结肠癌患者，采用一致的根治性手术方法，其生存率超过了大多数已发表系列研究的生存率，且未牺牲低并发症率。此外，III期患者的辅助化疗显著提高了生存率。
