Mackay G, Downey M, Molloy R G, O'Dwyer P J
Department of General Surgery, Western Infirmary.
Colorectal Dis. 2006 Jan;8(1):34-6. doi: 10.1111/j.1463-1318.2005.00866.x.
The indications for pre-operative radiotherapy in rectal cancer are still unclear with the exception of T4 tumours. The aim of this study was to assess local and overall recurrence in patients with T1-T3 rectal cancers undergoing total mesorectal excision (TME).
Prospective data was collected from 150 patients with rectal cancer treated in one surgical centre between July 1997 and July 2002. One hundred and twenty-nine primary resections were carried of which 102 were with curative intent. Seventy-nine patients with T1-T3 tumours were included in the analysis. Nine had local resections and 70 underwent TME; 19 of the 70 patients were node positive and 51 were node negative.
At a median follow-up of 37 months (range 19-79 months) there were 3 (4.3%) isolated local recurrences. One node positive patient developed isolated local recurrence compared with 2 node negative patients. The node positive patient died from a myocardial infarction while the two node negative patients died as a consequence of local recurrence. Three (4.3%) of 70 patients developed systemic relapse all of whom were node positive. The cancer specific mortality rate over the same follow-up period was 3/19 for node positive patients and 2/51 for node negative patients. Of 9 patients who had local resections, none developed local recurrence or systemic relapse.
With TME the rate of local recurrence in T1-T3 tumours is low. Our results do not support the use of pre-operative radiotherapy for these patients.
除T4期肿瘤外，直肠癌术前放疗的指征仍不明确。本研究的目的是评估接受全直肠系膜切除术（TME）的T1 - T3期直肠癌患者的局部和总体复发情况。
收集了1997年7月至2002年7月在一个外科中心接受治疗的150例直肠癌患者的前瞻性数据。进行了129例原发性切除术，其中102例为根治性切除。79例T1 - T3期肿瘤患者纳入分析。9例行局部切除术，70例行TME；70例患者中有19例淋巴结阳性，51例淋巴结阴性。
中位随访37个月（范围19 - 79个月），有3例（4.3%）孤立性局部复发。1例淋巴结阳性患者发生孤立性局部复发，而2例淋巴结阴性患者发生。淋巴结阳性患者死于心肌梗死，2例淋巴结阴性患者死于局部复发。70例患者中有3例（4.3%）发生全身复发，均为淋巴结阳性。在相同随访期内，淋巴结阳性患者的癌症特异性死亡率为3/19，淋巴结阴性患者为2/51。9例行局部切除术的患者均未发生局部复发或全身复发。
采用TME，T1 - T3期肿瘤的局部复发率较低。我们的结果不支持对这些患者使用术前放疗。
