Kruschewski M, Pohlen U, Hotz H G, Ritz J-P, Kroesen A J, Buhr H J
Chirurgische Klinik und Hochschulambulanz I, Charité -- Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin.
Zentralbl Chir. 2006 Jun;131(3):217-22. doi: 10.1055/s-2006-933467.
In about 10 % of all patients with colorectal cancer, the primary invention already discloses adhesions or infiltration of adjacent organs. En bloc resection of the tumor-bearing bowel segment with adjacent organs is done to give patients a chance for curation, since intraoperative differentiation is not possible. The aim of this study is characterization of the patient population as well as evaluation of the morbidity and mortality associated with this type of extensive intervention.
Between 1/95 and 6/04, we analyzed all patients with progressive primary colorectal cancer, who underwent multivisceral surgery with en bloc resection of at least one other organ. The target parameters were tumor characteristics as well as postoperative morbidity and mortality.
A total of 1 001 patients with colorectal cancer underwent surgery. 101 patients (10 %) required multivisceral resection. In 17 % the indication was exigent. About 70 % of the interventions involved the colon. Tumor perforation was seen in 17 % of patients with colon cancer and 16 % with rectal cancer. Resection of the inner genitals was most frequent in both colon and rectal cancer (26 and 84 %) followed by small bowel resection (21 %) and partial bladder resection (19 %). Other organs play a secondary role in rectal cancer while partial bladder resection (20 %) and abdominal wall resection (14 %) is observed more frequently in colon cancer. Resection of parenchymatous organs (kidney, suprarenal gland, spleen, pancreas, liver) and others like the stomach is quite rare in colon cancer. Actual tumor infiltration (T4 situation) was observed in 51 % of patients with colon cancer and in 64 % of those with rectal cancer. Local R0 resection (97 vs. 96 %) was successfully performed in nearly all colon and rectal cancer patients. The surgical major complication rate was 9 % in colon cancer and 19 % in rectal cancer. The mortality rate was 4 %.
Multivisceral en-bloc resection enables local R0 resection in the majority of cases with primary colorectal cancer. Despite sometimes extensive surgery, this type of procedure is associated with an acceptable morbidity and mortality. Since long-term survival is comparable to that in the T category (T3 or T4), multivisceral en-bloc resection is not only justified but also absolutely required in interventions with curative intention.
在所有结直肠癌患者中，约10%的患者其原发灶已显示出与相邻器官的粘连或浸润。由于术中无法进行鉴别，因此需将携带肿瘤的肠段与相邻器官整块切除，以使患者有治愈的机会。本研究的目的是对患者群体进行特征描述，并评估与这种广泛干预相关的发病率和死亡率。
在1995年1月至2004年6月期间，我们分析了所有患有进展期原发性结直肠癌且接受了多脏器手术并至少整块切除一个其他器官的患者。目标参数为肿瘤特征以及术后发病率和死亡率。
共有1001例结直肠癌患者接受了手术。101例患者（10%）需要进行多脏器切除。其中17%的手术指征紧急。约70%的手术涉及结肠。17%的结肠癌患者和16%的直肠癌患者出现肿瘤穿孔。在结肠癌和直肠癌中，切除内生殖器最为常见（分别为26%和84%），其次是小肠切除（21%）和部分膀胱切除（19%）。在直肠癌中，其他器官起次要作用，而在结肠癌中，部分膀胱切除（20%）和腹壁切除（14%）更为常见。在结肠癌中，切除实质性器官（肾、肾上腺、脾、胰腺、肝）以及其他如胃等器官相当罕见。51%的结肠癌患者和64%的直肠癌患者观察到实际肿瘤浸润（T4情况）。几乎所有结肠癌和直肠癌患者均成功进行了局部R0切除（分别为97%和96%）。结肠癌的手术主要并发症发生率为9%，直肠癌为19%。死亡率为4%。
多脏器整块切除在大多数原发性结直肠癌病例中能够实现局部R0切除。尽管有时手术范围广泛，但这种手术方式的发病率和死亡率是可以接受的。由于长期生存率与T分类（T3或T4）患者相当，因此多脏器整块切除在有治愈意图的干预中不仅合理，而且是绝对必要的。
