Muruve Nicolas
Department of Surgery, Division of Urology, Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri, USA.
Can J Urol. 2003 Apr;10(2):1815-8.
Total pelvic exenteration (TPE) is the standard of care for locally advanced colorectal cancer. This is a morbid procedure often leaving the patient with two ostomy sites and an extended recovery. Bladder preservation with complete tumor resection is often possible in these cases and we set out to determine if limited resection of the GU tract was as effective in tumor control as TPE.
This is a retrospective review of all patients over a 7-year period with colorectal tumors invading the urinary system. These patients were divided into two groups based upon the surgical procedure they received: TPE or GU tract sparing surgery. Tumor stage, adjuvant cancer therapy, and complications were reviewed. Recurrence and survival rates were calculated.
There were 19 patients with colorectal tumors invading the GU tract. Eight patients were treated with TPE and 11 patients received GU tract sparing procedures. Tumor stage and extent of disease were similar for both groups as were adjuvant/neoadjuvant therapy received. The average follow up from surgery for TPE and GU tract sparing procedures was 40 months (range 9 - 96) and 53 months (range 21.5 - 94), respectively. The limited resection and TPE groups experienced similar complication rates: 7/11 (63.6%) and 6/8 (75%) respectively. The 5-year survival rate was 37.5% and 61.4% for TPE and limited GU resections, respectively (p=0.07).
The cancer recurrence and complication rates were similar in both groups offering no clear advantage to TPE. GU sparing surgery in the face of locally invasive colorectal tumors is a viable option allowing for treatment of the disease and reducing the morbidity of total pelvic exenteration.
全盆腔脏器切除术（TPE）是局部晚期结直肠癌的标准治疗方法。这是一种创伤性较大的手术，常常会给患者留下两个造口部位，且恢复时间较长。在这些病例中，通常可以在完整切除肿瘤的同时保留膀胱，我们着手确定对泌尿生殖系统进行有限切除在肿瘤控制方面是否与TPE一样有效。
这是一项对7年间所有患有侵犯泌尿系统的结直肠肿瘤患者的回顾性研究。根据患者接受的手术方式将这些患者分为两组：TPE组或保留泌尿生殖系统手术组。对肿瘤分期、辅助性癌症治疗及并发症进行了评估。计算了复发率和生存率。
有19例结直肠肿瘤侵犯泌尿生殖系统的患者。8例患者接受了TPE治疗，11例患者接受了保留泌尿生殖系统的手术。两组的肿瘤分期和疾病范围以及接受的辅助/新辅助治疗相似。TPE组和保留泌尿生殖系统手术组术后的平均随访时间分别为40个月（范围9 - 96个月）和53个月（范围21.5 - 94个月）。有限切除组和TPE组的并发症发生率相似，分别为7/11（63.6%）和6/8（75%）。TPE组和有限泌尿生殖系统切除组的5年生存率分别为37.5%和61.4%（p = 0.07）。
两组的癌症复发率和并发症发生率相似，TPE并无明显优势。对于局部浸润性结直肠肿瘤，保留泌尿生殖系统手术是一种可行的选择，既能治疗疾病，又能降低全盆腔脏器切除术的发病率。
