Al-Sanea Nasser, Isbister William H
Department of Surgery, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
ANZ J Surg. 2004 Apr;74(4):229-32. doi: 10.1111/j.1445-2197.2004.02946.x.
At some time, every general surgeon will be faced with the task of trying to decide what to do with a patient who presents with rectal cancer and unresectable distant metastases. How safe is resectional surgery? What sort of palliation may be expected following resection of the primary tumour? In an attempt to answer these questions, the management and outcomes of all patients with rectal cancer and distant metastases, who were primarily referred to the colorectal unit at King Faisal Specialist Hospital were examined.
All patients who underwent primary surgery for rectal cancer in the presence of metastatic disease were identified. The charts of these patients were examined and their morbidity, mortality and survival were determined.
Over an 8-year period 22 patients (average age 54 years) underwent rectal resectional surgery in the presence of metastatic disease. There were 13 men and nine women. The commonest complaint was rectal bleeding. All patients had chest radiographs. Pulmonary metastases were identified in four patients. Nineteen abdominal and pelvic computed tomography scans were performed and eight showed evidence of metastases. Skeletal radiographs in two patients showed evidence of bone metastasis. At operation, intraperitoneal metastases were found in 18 patients. Nine of these were not identified preoperatively. Six patients underwent abdomino-perineal resection, nine anterior resection and seven a Hartmann's procedure. Eight patients developed a significant postoperative complication and one died 42 days after surgery. The mean length of hospital stay was 18.6 days. Nine patients received preoperative radiotherapy. Four patients had palliative radiotherapy, two for bony, one for liver and one for peritoneal metastases. Patients were followed up for a mean of 1.1 years. During follow up, 11 returned to the emergency room on 24 occasions. Two patients required readmission. No patient had further rectal bleeding. The mean survival was 1.3 years.
Patients with rectal cancer and unresectable distant metastases can be successfully palliated by resection of the primary tumour with low morbidity and mortality. The early involvement of a palliative care team facilitates patient management and helps patients enjoy what remains of the rest of their lives at home, in comfort and with good symptom control.
在某些时候，每位普通外科医生都会面临这样一项任务，即试图决定如何处理患有直肠癌且伴有不可切除远处转移灶的患者。根治性手术的安全性如何？切除原发肿瘤后可预期何种程度的姑息治疗效果？为了回答这些问题，我们对所有主要转诊至法赫德国王专科医院结直肠科的患有直肠癌和远处转移灶的患者的治疗及预后情况进行了研究。
确定所有因转移性疾病接受直肠癌一期手术的患者。检查这些患者的病历，并确定其发病率、死亡率和生存率。
在8年期间，22例患者（平均年龄54岁）在存在转移性疾病的情况下接受了直肠根治性手术。其中男性13例，女性9例。最常见的症状是直肠出血。所有患者均进行了胸部X线检查。4例患者发现有肺转移。进行了19次腹部和盆腔计算机断层扫描，其中8例显示有转移证据。2例患者的骨骼X线片显示有骨转移证据。手术时，18例患者发现有腹腔内转移。其中9例术前未被发现。6例患者接受了腹会阴联合切除术，9例接受了前切除术，7例接受了哈特曼手术。8例患者术后出现严重并发症，1例在术后42天死亡。平均住院时间为18.6天。9例患者接受了术前放疗。4例患者接受了姑息性放疗，2例针对骨转移，1例针对肝转移，1例针对腹腔转移。对患者进行了平均1.1年的随访。随访期间，11例患者24次返回急诊室。2例患者需要再次入院。没有患者再次出现直肠出血。平均生存期为1.3年。
患有直肠癌且伴有不可切除远处转移灶的患者通过切除原发肿瘤可成功获得姑息治疗，且发病率和死亡率较低。姑息治疗团队的早期介入有助于患者管理，并帮助患者在家中舒适地度过余生，同时症状得到良好控制。
