Hang Jian-Wei, Zhou Zhi-Xiang, Bu Yong-Qiang, Bai Xiao-Feng, Wang Xiang, Zhao Ping
Department of Abdominal Surgical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2007 Feb;29(2):141-3.
To investigate the factors affecting the result and selection of local excision for low rectal cancer.
The clinical data of 101 patients with low rectal cancer treated by local excision were retrospectively analyzed. Survival was estimated using the Kaplan-Meier. The factors influencing on the survival were analyzed using univariate (Log rank) and multivariate (Cox model) analysis methods.
Of 101 patients in this series, 91 patients underwent transanal excision, 9 had transsacral excision, 1 recieved transvaginal excision. Postopertative complication developed in 6 patients (5.9%). No death occurred within 30 postoperative days. Five T4 patients underwent preoperative radiotherapy, and 34 received postoperative radiotherapy. The overall 5-year survival rate was 91.0% for the whole group, and it was 100%, 92.6%, 77.1%, 83.3% for patients with Tis, T1, T2, and T3/T4 lesion, respectively. The incidence of local recurrence was 15. 8%. Univariate analysis revealed that pathological T stage, tumor size (> 3 cm), lymphovascular invasion, ulcerative lesion, adjuvant radiotherapy and local recurrence were significant factors affecting the survival (P <0.05). However, by multivariate analysis, only tumor size ( > 3 cm) and local recurrence were found to be the significant prognostic predictors.
The important selection criteria for local excision in the treatment of low rectal cancer may include T1 stage, well or moderate differentiation,tumor size < or = 3 cm, no lymphovascular invasion.
探讨影响低位直肠癌局部切除结果及选择的因素。
回顾性分析101例行局部切除的低位直肠癌患者的临床资料。采用Kaplan-Meier法估计生存率。采用单因素（Log rank）和多因素（Cox模型）分析方法分析影响生存的因素。
本系列101例患者中，91例行经肛门切除，9例行经骶骨切除，1例行经阴道切除。6例患者（5.9%）发生术后并发症。术后30天内无死亡病例。5例T4期患者术前行放疗，34例接受术后放疗。全组5年总生存率为91.0%，Tis、T1、T2和T3/T4期病变患者的5年生存率分别为100%、92.6%、77.1%和83.3%。局部复发率为15.8%。单因素分析显示，病理T分期、肿瘤大小（>3 cm）、淋巴管侵犯、溃疡病变、辅助放疗和局部复发是影响生存的显著因素（P<0.05）。然而，多因素分析显示，只有肿瘤大小（>3 cm）和局部复发是显著的预后预测因素。
低位直肠癌局部切除的重要选择标准可能包括T1期、高分化或中分化、肿瘤大小≤3 cm、无淋巴管侵犯。
