Austgen T R, Souba W W, Bland K I
Department of Surgery, University of Florida, Gainesville.
Surg Clin North Am. 1991 Feb;71(1):175-92. doi: 10.1016/s0039-6109(16)45341-7.
In the management of the patient with intra-abdominal recurrence of colorectal carcinoma, surgery remains the primary mode of therapy when cure or significant palliation is anticipated. Appreciation of the importance of close follow-up after primary resection coupled with improved diagnostic modalities has allowed the surgeon not only to detect earlier recurrence but also to select the patients most likely to benefit from resection of recurrent disease. Improved surgical techniques with resultant decreases in the rates of morbidity and mortality have allowed safe hepatic resection of metastatic disease. In selected patients, this procedure produces 5-year survival rates approaching 50%. Although a clear consensus has not been reached, most studies agree that positive prognostic indicators include absence of extrahepatic disease, a small number of intrahepatic lesions, a low CEA level, and a better Dukes stage of the primary. Likewise, in the patient with recurrent disease locally, surgery provides the only means of cure and also plays a significant role in palliation. Aggressive resection with generous surgical margins in patients with contained disease may yield 5-year survival rates approaching 35%. In patients with unresectable disease and even in those with carcinomatosis, palliation can be obtained by surgical therapy. Judgment is necessary in treating these patients both preoperatively and intraoperatively. Surgical intervention for obstruction, perforation, or other anatomic or physiological compromise is often indicated and can improve the quality of life of the patient with intra-abdominal recurrence.
在结直肠癌腹腔内复发患者的管理中，当预期可治愈或显著缓解病情时，手术仍然是主要的治疗方式。认识到初次切除后密切随访的重要性，并结合改进的诊断方法，使外科医生不仅能够更早地检测到复发，还能选择最有可能从复发性疾病切除中获益的患者。手术技术的改进导致发病率和死亡率降低，从而使转移性疾病的肝脏切除变得安全。在选定的患者中，该手术的5年生存率接近50%。虽然尚未达成明确共识，但大多数研究一致认为，阳性预后指标包括无肝外疾病、肝内病变数量少、癌胚抗原（CEA）水平低以及原发肿瘤的Dukes分期较好。同样，对于局部复发性疾病患者，手术是唯一的治愈方法，在缓解病情方面也起着重要作用。对局限性疾病患者进行广泛切缘的积极切除，5年生存率可能接近35%。对于无法切除的疾病患者，甚至是患有癌性腹膜炎的患者，手术治疗也可实现病情缓解。在治疗这些患者时，术前和术中都需要进行判断。对于梗阻、穿孔或其他解剖或生理功能受损的情况，通常需要进行手术干预，这可以提高腹腔内复发患者的生活质量。
