Derici H, Unalp H R, Kamer E, Bozdag A D, Tansug T, Nazli O, Kara C
3rd General Surgery Clinic, Atatürk Training and Research Hospital, Izmir, Turkey.
Colorectal Dis. 2008 Jun;10(5):453-9. doi: 10.1111/j.1463-1318.2007.01427.x. Epub 2007 Dec 7.
The aim of this study was to evaluate the effectiveness of en bloc multivisceral resection of organs involved by locally advanced rectal carcinoma.
A total of 312 patients with primary rectal cancer underwent surgery between January 1994 and April 2005. Of these, 57 patients (18.3%) had macroscopically direct invasion of an adjacent organ or structure, and underwent multivisceral resection with curative intent. Survival analyses were made by the Kaplan-Meier and the Cox proportional hazards regression model.
The postoperative mortality was 3.5%. The overall survival rate at 1, 3 and 5 years was 96.4%, 81.6% and 49.0%. Age (> or = 65 years), depth of tumour invasion (pT3 stage), lymph node status (pN0), tumour stage (III A-B), grading (G1), vascular and neural invasion (not extensive), type of adhesion (inflammatory) and type of resection (R0) were significant factors favouring survival in the univariate analysis. Only two factors, lymph node status pN0 (P = 0.007) and R0 resection (P = 0.005) were independently significant factors in the multivariate analysis.
R0 resection and pN0 status influence overall survival for locally advanced rectal carcinoma.
本研究旨在评估对局部进展期直肠癌累及器官进行整块多脏器切除的有效性。
1994年1月至2005年4月期间，共有312例原发性直肠癌患者接受了手术。其中，57例（18.3%）肉眼可见肿瘤直接侵犯相邻器官或结构，并接受了旨在治愈的多脏器切除。采用Kaplan-Meier法和Cox比例风险回归模型进行生存分析。
术后死亡率为3.5%。1年、3年和5年的总生存率分别为96.4%、81.6%和49.0%。在单因素分析中，年龄（≥65岁）、肿瘤浸润深度（pT3期）、淋巴结状态（pN0）、肿瘤分期（ⅢA-B期）、分级（G1）、血管和神经侵犯（不广泛）、粘连类型（炎性）和切除类型（R0）是有利于生存的显著因素。在多因素分析中，只有两个因素，即淋巴结状态pN0（P = 0.007）和R0切除（P = 0.005）是独立的显著因素。
R0切除和pN0状态影响局部进展期直肠癌的总生存。
