Ike Hideyuki, Shimada Hiroshi, Ohki Shigeo, Yamaguchi Shigeki, Ichikawa Yasushi, Fujii Shouichi
Second Department of Surgery, Yokohama City University, Yokohama, Japan.
Hepatogastroenterology. 2003 May-Jun;50(51):700-3.
BACKGROUND/AIMS: Local recurrence occurs in 10 to 30% of patients with rectal cancer following curative resection. However treatment of choice remains controversial. We assessed the results of total pelvic exenteration for locally recurrent cancer of the rectum retrospectively.
We reviewed medical charts of 45 patients with rectal cancer who underwent curative total pelvic exenteration for local recurrence. The cause of recurrence was classified into four groups: anastomotic, surgical cut-end, implantation, and lymphatic based on pathologic findings and computed tomography. Long-term survival was correlated with clinicopathologic variables.
Postoperative morbidity was 77.8% and in-hospital death occurred in 13.3% of patients. The overall 5-year survival rate was 14.1%. The 5-year survival rates stratified according to the expectation of curability were 31.6% for absolutely curative resection, 7.8% for relatively curative resection, and 0% for non-curative resection. Multivariate analysis revealed that the disease-free interval was the only independent prognostic factor. There was no benefit from perioperative radiation or intraoperative continuous pelvic peritoneal perfusion of the pelvis.
Total pelvic exenteration for local recurrence of rectal cancer can achieve long-term survival when curative resection is possible and the disease-free interval is long.
背景/目的：根治性切除术后，10%至30%的直肠癌患者会出现局部复发。然而，治疗方案的选择仍存在争议。我们回顾性评估了全盆腔脏器切除术治疗局部复发性直肠癌的结果。
我们回顾了45例因局部复发而接受根治性全盆腔脏器切除术的直肠癌患者的病历。根据病理结果和计算机断层扫描，将复发原因分为四组：吻合口、手术切端、种植和淋巴转移。长期生存率与临床病理变量相关。
术后发病率为77.8%，13.3%的患者发生院内死亡。总体5年生存率为14.1%。根据可治愈性预期分层的5年生存率，绝对根治性切除为31.6%，相对根治性切除为7.8%，非根治性切除为0%。多因素分析显示，无病间期是唯一的独立预后因素。围手术期放疗或术中持续盆腔腹膜灌注盆腔均无益处。
对于局部复发性直肠癌，当可能进行根治性切除且无病间期较长时，全盆腔脏器切除术可实现长期生存。
