Killingback M
Hornsby Kuringai District Hospital, Australia.
World J Surg. 1992 May-Jun;16(3):437-46. doi: 10.1007/BF02104444.
To discuss indications for local excision of adenocarcinoma of the low rectum, two different series of patients were analysed. Series I consisted of 60 patients treated by local excision from 1969 to 1985 in whom local recurrence developed. Series II consisted of 59 patients who underwent resection for non high grade tumors less than or equal to 3.5 cm from 1980 to 1990 in whom lymph node spread was studied. A distinction is made between tumors which are obvious cancers and malignant polyps, and the discussion of indications for local excision is orientated to the former. The results of local excision have been disappointing but a number of compromise selections for local excision have been necessary. Endorectal ultrasound has emerged as the most important method of assessing the depth of invasion of the tumor. Stratifying the depth of the tumor is at present the most important prognostic indicator for lymph node metastasis and local recurrence in non high grade tumors. If the muscle layer is invaded by tumor, local metastasis will occur in 17% of patients. It is likely that only tumors involving superficial layers of muscle are suitable for local excision, but this needs further study. Mucinous carcinomas and the presence of lymphatic invasion are contra-indications to local excision. The shape and size of tumors are not independent prognostic indicators. The techniques available for local excision alter the indications. Salvage operations for recurrence after local excision have proved disappointing.
为探讨低位直肠癌局部切除的适应证，对两组不同的患者进行了分析。第一组包括1969年至1985年接受局部切除且发生局部复发的60例患者。第二组包括1980年至1990年因肿瘤未达高级别且距肛缘小于或等于3.5 cm而接受切除的59例患者，对其淋巴结转移情况进行了研究。区分明显癌性肿瘤和恶性息肉，局部切除适应证的讨论主要针对前者。局部切除的结果令人失望，但进行一些折中的局部切除选择是必要的。直肠内超声已成为评估肿瘤浸润深度的最重要方法。目前，对肿瘤深度进行分层是评估非高级别肿瘤淋巴结转移和局部复发最重要的预后指标。如果肿瘤侵犯肌层，17%的患者会发生局部转移。可能只有累及浅肌层的肿瘤适合局部切除，但这需要进一步研究。黏液腺癌和存在淋巴管浸润是局部切除的禁忌证。肿瘤的形状和大小并非独立的预后指标。现有的局部切除技术会改变适应证。局部切除术后复发的挽救性手术结果令人失望。
