Schaal J C, Mondino J C, Paris F, Piat J M, Jaeck D
Service de Chirurgie Générale et Endocrinienne, Hôpital de Hautepierre, Strasbourg.
J Chir (Paris). 1991 Nov;128(11):476-80.
The frequency of synchronous colorectal cancers ranges from 1.7 to 9.3% according to the series. The incidence of these cancers has been appreciated in various ways, according to variable diagnostic criteria, especially because some authors have included in situ carcinomas developing on degenerated polyps. A retrospective study of the synchronous cancers operated in our department from January, 1980 to August, 1990 allowed us to assess their frequency and location and to discuss the therapeutic choices. Two hundred and forty-nine patients with cancers of the colon or of the rectum have been operated during that period. Twelve (4.8%) presented with more than one colorectal cancer, all discovered simultaneously. The average age of the patients operated for synchronous cancer was higher that that of those operated of isolate cancer (68.8 years versus 63.3). Two thirds of the synchronous cancers were located in the sigmoid loop or the colon and, in one third of all cases, on non-adjacent segments of the colon. The frequent association of colic adenomatous polyps and of synchronous cancers--in one half of the patients in our series--must raise a discussion on the merits of systematic subtotal, or even total, colectomy in the treatment of synchronous colorectal cancers. This is also true for tumoral sites in 2 different segments of the colon. Segmental colectomy may be advocated in the other cases: cancers located on one segment, polyps located only on the resected segment of the colon, or polyps that can be resected via endoscopy.
根据系列研究，同时性结直肠癌的发生率在1.7%至9.3%之间。由于诊断标准不同，这些癌症的发病率有多种评估方式，特别是因为一些作者将在退化性息肉上发生的原位癌也包括在内。对1980年1月至1990年8月在我们科室接受手术的同时性癌症进行回顾性研究，使我们能够评估其发生率和位置，并讨论治疗选择。在此期间，有249例结肠癌或直肠癌患者接受了手术。其中12例（4.8%）患有不止一处结直肠癌，均为同时发现。接受同时性癌症手术患者的平均年龄高于接受孤立性癌症手术患者（68.8岁对63.3岁）。三分之二的同时性癌症位于乙状结肠袢或结肠，在所有病例的三分之一中，位于结肠的非相邻节段。在我们的系列研究中，一半患者的结肠腺瘤性息肉与同时性癌症频繁相关，这必然引发关于在治疗同时性结直肠癌时进行系统性次全结肠切除术甚至全结肠切除术优点的讨论。对于结肠两个不同节段的肿瘤部位也是如此。在其他情况下可主张行节段性结肠切除术：癌症位于一个节段，息肉仅位于结肠的切除节段，或息肉可通过内镜切除。
