直肠癌根治性低位前切除术后的局部复发

Safioleas Michael C, Moulakakis Konstantinos G, Stamatakos Michael, Kountouras Jannis, Lygidakis Nikolaos J

2nd Propaedeutic Surgical Department of the University of Athens, Laiko Hospital, Athens, Greece.

Hepatogastroenterology. 2005 Jan-Feb;52(61):94-6.

BACKGROUND/AIMS: Local recurrence is a formidable problem after potentially curative resection for rectal cancer. We attempted to identify possible factors affecting the frequency of local recurrence, focusing on the clearance of the tumor and the margin of resection.

METHODOLOGY

The clinical cohort consisted of 66 patients suffering from rectal carcinoma. All patients underwent a low anterior resection with meticulous pelvic preparation and dissection. The proximal and distal margins of the tumor were measured before fixing for permanent sections.

RESULTS

Analysis by distance of the tumor from the anal verge revealed that 5 out of 33 patients (15.15%) from the upper rectal group and 7 out of 19 patients (36.8%) from the mid rectal group developed local recurrences (36.8% vs. 15.15% P=0.0369). Analysis by distance of the distal resection margins revealed that 8 out of 12 patients with local recurrence had distal margins less than 2cm, whereas 7 out of 40 patients free of local relapse had margins less than 2cm. Therefore 8 out of 15 patients with distal margins less than 2cm developed local recurrence (53.5%) whereas 4 patients among 37 with margins greater than 2cm developed a local failure (10.8%) (53.5% vs. 10.8% P=4.88E-04). The median survival in all patients of our series was 23 months. The median survival in 52 patients who underwent a potentially curative resection was 42 months.

CONCLUSIONS

Tumors located in the upper portion of the rectum presented a minor tendency for local recurrence compared to tumors located in the middle of the rectum. Our study provides strong indications that high rate of local recurrences are probably related to the limited anatomic margins that can be obtained in the pelvis during primary resections.

背景/目的：对于直肠癌进行潜在根治性切除术后，局部复发是一个棘手的问题。我们试图确定影响局部复发频率的可能因素，重点关注肿瘤清除情况和切除切缘。

方法

临床队列由66例直肠癌患者组成。所有患者均接受低位前切除术，并进行了细致的盆腔准备和解剖。在固定用于制作永久切片之前，测量肿瘤的近端和远端切缘。

结果

根据肿瘤距肛缘的距离进行分析显示，直肠上段组33例患者中有5例（15.15%）发生局部复发，直肠中段组19例患者中有7例（36.8%）发生局部复发（36.8%对15.15%，P = 0.0369）。根据远端切除切缘的距离进行分析显示，12例局部复发患者中有8例远端切缘小于2cm，而40例无局部复发的患者中有7例切缘小于2cm。因此，15例远端切缘小于2cm的患者中有8例发生局部复发（53.5%），而37例切缘大于2cm的患者中有4例发生局部复发（10.8%）（53.5%对10.8%，P = 4.88×10⁻⁴）。我们系列研究中所有患者的中位生存期为23个月。52例接受潜在根治性切除的患者的中位生存期为42个月。