Killingback M, Barron P, Dent O F
Sydney Adventist Hospital, Australia.
Dis Colon Rectum. 2001 Apr;44(4):473-83; discussion 483-6. doi: 10.1007/BF02234317.
The aim of this article was to examine local recurrence after curative resection for carcinoma of the rectum in which the surgical technique of total mesorectal excision was not performed.
A single surgeon managed the patients and the data collected prospectively. Total excision of the distal mesorectum was not performed in the upper third or mid rectum.
From 1969 to 1993 curative resections were performed in 549 patients, of which 17 died postoperatively, leaving 532 for analysis. Sphincter-saving resection was performed in 468 patients (88 percent) and abdominoperineal excision in 58 (10.9 percent). The pathology stages (Dukes) were A, 158 (29.7 percent); B, 184 (34.7 percent); and C, 190 (35.7 percent). Five hundred seventeen patients (97.2 percent) were followed up for a minimum of five years. The median period of follow-up was 82 months. Local recurrence confined to the pelvis occurred in 17 patients, and local recurrence associated with distant metastases occurred in 24 patients. The total five-year local recurrence rate was 7.6 percent. Local recurrence was increased in Stage C tumors (P = <0.0001). Diathermy dissection in the pelvis was associated with a decreased local recurrence rate (P = 0.023). The five-year survival rate in curative resections was 72.5 percent.
It is essential that articles presenting local recurrence rates should include both local recurrence in isolation and that which occurs with distant metastases. Although total mesorectal excision for rectal cancer was not performed in this study, the local recurrence rate is not materially different from that in several articles where total mesorectal excision has been used. Whether the distal mesorectum needs to be pursued in mid-rectal cancer is not yet proven.
本文旨在研究未采用全直肠系膜切除术这一手术技术对直肠癌进行根治性切除术后的局部复发情况。
由一位外科医生负责这些患者，并前瞻性地收集数据。在直肠上三分之一或中直肠部位未进行远端直肠系膜的完全切除。
1969年至1993年期间，对549例患者实施了根治性切除术，其中17例术后死亡，剩余532例用于分析。468例患者（88%）实施了保肛手术，58例（10.9%）实施了腹会阴联合切除术。病理分期（Dukes分期）为A期158例（29.7%）；B期184例（34.7%）；C期190例（35.7%）。517例患者（97.2%）接受了至少5年的随访。中位随访时间为82个月。局限于盆腔的局部复发患者有17例，伴有远处转移的局部复发患者有24例。总的五年局部复发率为7.6%。C期肿瘤的局部复发率有所增加（P = <0.0001）。盆腔内的电刀分离与局部复发率降低相关（P = 0.023）。根治性切除术后的五年生存率为72.5%。
报告局部复发率的文章必须同时包含孤立性局部复发以及伴有远处转移的局部复发情况。尽管本研究未对直肠癌实施全直肠系膜切除术，但局部复发率与其他几篇采用全直肠系膜切除术的文章相比并无实质性差异。直肠癌中是否需要切除远端直肠系膜尚未得到证实。
