Bannura G C, Barrera A E, Cumsille M A G, Contreras J P, Melo C L, Soto D C, Mansilla J E
Department of Colorectal Surgery, Hospital Clinico San Borja Arriaran, Santiago, Chile.
Colorectal Dis. 2006 May;8(4):309-13. doi: 10.1111/j.1463-1318.2005.00938.x.
Indications for and the prognosis of posterior pelvic exenteration (PPE) in rectal cancer patients are not clearly defined. The aim of this study was to analyse the indications, complications and long-term results of PPE in patients with primary rectal cancer.
A retrospective review included patient demographics, tumour and treatment variables, and morbidity, recurrence, and survival statistics. These results were compared with a group of female patients who underwent standard resection for primary rectal cancer in the same period (non PPE group).
The series included 30 women with an average age of 56.7 years (range 22-78). Tumour location was recorded in three cases in the upper rectum, 13 cases in the medium rectum and 14 cases in the lower rectum. A sphincter-preserving procedure was performed in 70% of the patients. Mean operative time was 4.2 h (range 2-7.5 h). Overall major morbidity rate in this series was 50% and mean hospital stay was 19.7 days (range 9-60 days). There was no hospital mortality. Pathological reports showed direct invasion of uterus, vagina or rectovaginal septum in 19 cases, involvement of perirectal tissue in 25 cases and positive lymph nodes in 18 cases. Comparison between PPE and non PPE groups showed no differences in mean tumour diameter, histological grade and tumour stage, but patients in the first group were younger. Although low tumours were seen more frequently in the PPE group (P = 0.003), the rate of sphincter-preserving procedure was comparable in both groups. Operative time was longer (P = 0.04) and morbidity was higher (P = 0.0058) in the PPE group. Local recurrence with or without distant metastases for the whole series was 30%. Five-year survival rate for patients who underwent curative resections (TNM I-III) was 48% in the PPE group vs 62% in the non PPE group (P = 0.09).
In the present series, PPE prolonged operative time, increased postoperative complications and showed a trend toward poor prognosis in recurrence and survival. However, PPE offers the only hope for cure to patients with a primary rectal cancer that is adherent or invades reproductive organs.
直肠癌患者盆腔后脏器切除术（PPE）的适应证及预后尚无明确定义。本研究旨在分析原发性直肠癌患者行PPE的适应证、并发症及长期结果。
一项回顾性研究纳入了患者的人口统计学资料、肿瘤及治疗变量，以及发病率、复发率和生存统计数据。将这些结果与同期接受原发性直肠癌标准切除术的一组女性患者（非PPE组）进行比较。
该系列研究包括30名女性，平均年龄56.7岁（范围22 - 78岁）。肿瘤位于直肠上段3例，直肠中段13例，直肠下段14例。70%的患者接受了保留括约肌手术。平均手术时间为4.2小时（范围2 - 7.5小时）。该系列研究的总体主要发病率为50%，平均住院时间为19.7天（范围9 - 60天）。无医院死亡病例。病理报告显示，19例患者存在子宫、阴道或直肠阴道隔的直接侵犯，25例患者存在直肠周围组织受累，18例患者存在阳性淋巴结。PPE组与非PPE组比较，平均肿瘤直径、组织学分级和肿瘤分期无差异，但第一组患者更年轻。虽然PPE组低位肿瘤更为常见（P = 0.003），但两组保留括约肌手术的比例相当。PPE组手术时间更长（P = 0.04），发病率更高（P = 0.0058）。整个系列有或无远处转移的局部复发率为30%。接受根治性切除术（TNM I - III期）的患者，PPE组的5年生存率为48%，非PPE组为62%（P = 0.09）。
在本系列研究中，PPE延长了手术时间，增加了术后并发症，且在复发和生存方面显示出预后不良的趋势。然而，PPE为原发性直肠癌粘连或侵犯生殖器官的患者提供了唯一的治愈希望。
