Hind R, Rew D R, Johnson C D
University Surgical Unit, Southampton General Hospital.
Ann R Coll Surg Engl. 1992 Jan;74(1):63-7.
This debate examines the arguments for and against the proposal that surgical excision alone is adequate treatment for primary colorectal cancer. The arguments in favour are that the results from curative surgery are excellent and that despite many trials of adjuvant chemotherapy, radiotherapy and immunotherapy, the proposed benefits remain unproven. Recent improvements in surgical technique, particularly for dissection of rectal tumours, have shown the way towards further improvement using surgery alone, and it is clear from a national survey that technical factors related to individual surgeons play a large part in determining recurrence rates. With optimum primary treatment, surgical excision alone is indeed adequate therapy. The arguments against this motion are that although a considerable number of patients do survive with surgery, the 5-year survival rate is poor when there is extensive local invasion or lymphatic metastases. Surgery starts therapy by reducing the tumour load, but other modalities are required to destroy the cells which might subsequently develop into metastases. Trial results with adjuvant therapy are encouraging, although many contain too few patients. We cannot be content with the results of treatment of Dukes' Stage B and C tumours; more trials are needed to determine the best treatment for these patients.
本次辩论探讨了支持和反对仅通过手术切除作为原发性结直肠癌充分治疗方案的论据。支持该方案的论据是，根治性手术的效果极佳，而且尽管进行了许多辅助化疗、放疗和免疫治疗试验，但所宣称的益处仍未得到证实。手术技术最近有所改进，尤其是直肠肿瘤的解剖技术，这为仅通过手术进一步改善病情指明了方向，并且一项全国性调查清楚表明，与个体外科医生相关的技术因素在决定复发率方面起着很大作用。通过最佳的初始治疗，仅手术切除确实是充分的治疗方法。反对该提议的论据是，尽管相当数量的患者确实通过手术存活下来，但当存在广泛的局部侵犯或淋巴转移时，5年生存率很低。手术通过减少肿瘤负荷开始治疗，但还需要其他方式来消灭那些可能随后发展为转移灶的细胞。辅助治疗的试验结果令人鼓舞，尽管许多试验纳入的患者数量过少。我们不能满足于Dukes B期和C期肿瘤的治疗结果；需要更多试验来确定这些患者的最佳治疗方法。
