Law Wai Lun, Chu Kin Wah
Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong.
J Surg Oncol. 2006 Jun 1;93(7):523-8. doi: 10.1002/jso.20506.
There is no consensus as to the management of the primary rectal cancer in the presence of distant metastasis and data on the outcomes of radical resection in stage IV rectal cancer are limited. This study aims to evaluate the results of resection of rectal cancer in the patients with stage IV disease and to analyze the factors that might affect the survival of these patients.
Of the 744 patients with radical resection of primary rectal and rectosigmoid cancer during the study period from August 1993 to July 2002, 70 had stage IV disease on the initial presentation. The demographics, the operative details, the tumor characteristics, the postoperative outcomes and survival of the patients were collected prospectively. Factors influencing the survival were analyzed with univariate and multivariate analysis.
Fifty-three men and 17 women with a median age of 66 years (range: 31-90 years) were included. The median level of the tumor from the anal verge was 10 cm (range 3-20 cm). The operations included abdominoperineal resection (n = 5), anterior resection (n = 53), and Hartmanns operation (n = 11). The operation mortality was 4.3%. The overall morbidity was 42.7% while the surgical morbidity and the reoperation rates were 15.7% and 5%, respectively. The local recurrence rate was 4.3% and the 2-year actuarial rate was 7.8%. All the patients who had local recurrences also had disseminated peritoneal metastasis. The median cancer-specific survival of the patients who survived the surgery was 15.2 months. Multivariate analysis showed that the presence of gross residual local disease, lymph node metastasis, liver involvement of over 50%, the absence of surgical management of liver metastasis and those without chemotherapy were independent factors associated with poor survival.
Postoperative mortality and morbidity were acceptable in patients with stage IV rectal cancer. The local disease can be controlled effectively with radical resection. However, in patients with extensive liver involvement and advanced local disease, resection is not worthwhile because of the poor survival. Surgical management of the metastasis and the administration of chemotherapy are associated with better survival. However, the optional treatment regimes are yet to be defined.
对于存在远处转移的原发性直肠癌的治疗尚无共识，且关于IV期直肠癌根治性切除术后结果的数据有限。本研究旨在评估IV期疾病患者的直肠癌切除结果，并分析可能影响这些患者生存的因素。
在1993年8月至2002年7月的研究期间，744例行原发性直肠癌和直肠乙状结肠癌根治性切除的患者中，70例初诊时为IV期疾病。前瞻性收集患者的人口统计学资料、手术细节、肿瘤特征、术后结果和生存情况。采用单因素和多因素分析影响生存的因素。
纳入53例男性和17例女性，中位年龄66岁（范围：31 - 90岁）。肿瘤距肛缘的中位距离为10 cm（范围3 - 20 cm）。手术包括腹会阴联合切除术（n = 5）、前切除术（n = 53）和Hartmann手术（n = 11）。手术死亡率为4.3%。总体发病率为42.7%，手术发病率和再次手术率分别为15.7%和5%。局部复发率为4.3%，2年精算生存率为7.8%。所有发生局部复发的患者也有弥漫性腹膜转移。术后存活患者的中位癌症特异性生存期为15.2个月。多因素分析显示，存在肉眼可见的局部残留病灶、淋巴结转移、肝脏受累超过50%、未对肝转移进行手术处理以及未接受化疗是与生存不良相关的独立因素。
IV期直肠癌患者术后死亡率和发病率可接受。根治性切除可有效控制局部疾病。然而，对于肝脏广泛受累和局部疾病晚期的患者，由于生存率低，切除并不值得。转移灶的手术处理和化疗与更好的生存相关。然而，最佳治疗方案尚未确定。
