Asteria C R, Valanzano R, Marcucci T, Tonelli F
Unità di Chirurgia, Dipartimento di Fisiopatologia Chirurgica, Università degli Studi, Firenze.
Suppl Tumori. 2005 May-Jun;4(3):S5-6.
Much recent data have been published on the risk of local recurrence (LR) following curative surgery for rectal cancer and the impact of adjuvant therapy. On the other hand, improvements in surgical techniques, as the total mesorectal excision, have apparently reduced the risk of LR. Furthermore, in selected cases, neoadjuvant therapy seems to reduce much more the incidence of LR. A list of prognostic factors which affect the onset of LR, other than the different procedures, was considered. To investigate such evidences a retrospective analysis was undertaken in our series, focusing on examination of the employed techniques as potential predictors of local recurrence. Thus, in a 18-yr-period (1986-2003), two hundred and ninety-five patients who had undergone elective curative surgical resection of rectal cancer were included in the study. The demographic, operative and follow-up data were collected retrospectively. All patients underwent total mesorectal excision, whereas neoadjuvant therapy was performed in a selected series of patients, according to defined entry criteria patterns. Results evidenced LR in 7.1% of patients and occurred between 6 months to 8 year following surgery. Comparisons were made between patients who had different surgical procedures; indeed sphyncter saving procedures correlated with a higher incidence of LR rather than abdomino-perineal resection. Pelvic recurrences were observed more frequently compared to the anastomotic ones. A limited number of patients with LR underwent surgery due to the associated condition of metastatic lesions; the follow-up related to such series evidenced a mortality rate of 57% within 3 year from reoperation. A low local recurrence rate can be achieved after total mesorectal excision (TME) without preoperative radiotherapy. Our results suggest that preoperative radiotherapy may be employed only for those patients who are at a higher risk for local recurrence.
近期已发表了许多关于直肠癌根治性手术后局部复发（LR）风险及辅助治疗影响的数据。另一方面，诸如全直肠系膜切除术等手术技术的改进，显然降低了LR风险。此外，在特定病例中，新辅助治疗似乎能更大程度地降低LR发生率。我们考虑了一份除不同手术方式外影响LR发生的预后因素清单。为研究这些证据，我们对本系列病例进行了回顾性分析，重点考察所采用的技术作为局部复发潜在预测指标的情况。因此，在18年期间（1986 - 2003年），本研究纳入了295例行直肠癌择期根治性手术切除的患者。回顾性收集了患者的人口统计学、手术及随访数据。所有患者均接受了全直肠系膜切除术，而根据明确的入选标准模式，部分患者接受了新辅助治疗。结果显示7.1%的患者出现LR，发生在术后6个月至8年之间。对采用不同手术方式的患者进行了比较；事实上，保留括约肌手术与LR发生率较高相关，而非腹会阴联合切除术。与吻合口复发相比，盆腔复发更为常见。少数LR患者因伴有转移性病变而接受了手术；该系列患者的随访显示，再次手术后3年内死亡率为57%。在未进行术前放疗的情况下，全直肠系膜切除术（TME）后可实现较低的局部复发率。我们的结果表明，术前放疗可能仅适用于局部复发风险较高的患者。
