Kronborg O, Fenger C
Kirurgisk gastroenterologisk afdeling K, Odense Sygehus.
Ugeskr Laeger. 1991 Jun 17;153(25):1778-82.
The importance of local treatment for early colorectal cancer is apparent because of increasing endoscopical activity for diagnostic purposes and screening. Curative local treatment was attempted in 63 patients with polypoid, mobile tumours thought to be within the bowel wall and without palpable lymph nodes in the perirectal tissue. Tumours more than 3 cm in diameter were excluded, unless they were pedunculated or were believed to be adenomas with carcinoma. Removal was effected by polypectomy, piecemeal removal, peranal excision, posterior rectotomy or colotomy. Complications were few, and hospitalization was shorter than after conventional surgery, but one patient died from treatment. More extensive surgery followed in 12 patients, in whom cancer remained in the resection margin or where this could not be excluded. However, seven of the 12 patients had no residual cancer tissue. Survival without recurrence was longer in patients with tumours below 3 cm in diameter. Recurrence was seen in nine patients, but not in those with cancer limited to head and the stalk of pedunculated tumours and not with cancer limited to the luminal part of submucosa, regardless of shape of tumour. Adenoma in continuity with cancer did not influence survival significantly, but synchronous adenomas in other parts tended to increase recurrence-free survival. Local treatment is satisfactory in most patient with cancer within pedunculated polyps and in some with cancer in sessile polypopid tumours. Criteria of selection are not optimal and the use of endoluminal ultrasound examinations must be evaluated in prospective trials. At present, conventional surgery should be used when cancer in the resection margin cannot be excluded, when cancer is present in the deeper layers of muscularis propria and in patients with poorly differentiated cancers.
由于用于诊断目的和筛查的内镜检查活动日益增加，早期结直肠癌局部治疗的重要性显而易见。对63例息肉样、可移动的肿瘤患者尝试进行根治性局部治疗，这些肿瘤被认为位于肠壁内，直肠周围组织中未触及淋巴结。直径超过3 cm的肿瘤被排除在外，除非它们有蒂或被认为是伴有癌的腺瘤。切除通过息肉切除术、分块切除、经肛门切除、直肠后切开术或结肠切开术进行。并发症较少，住院时间比传统手术后短，但有1例患者死于治疗。12例患者随后进行了更广泛的手术，这些患者的切除边缘仍有癌或无法排除有癌。然而，这12例患者中有7例没有残留癌组织。直径小于3 cm的肿瘤患者无复发存活时间更长。9例患者出现复发，但带蒂肿瘤头部和蒂部局限有癌的患者以及黏膜下层管腔部分局限有癌的患者未出现复发，无论肿瘤形状如何。与癌相连的腺瘤对生存没有显著影响，但其他部位的同步腺瘤倾向于增加无复发生存率。对于大多数带蒂息肉内有癌的患者以及一些无蒂息肉样肿瘤中有癌的患者，局部治疗是令人满意的。选择标准并不理想，必须在前瞻性试验中评估腔内超声检查的应用。目前，当不能排除切除边缘有癌、肌层深层有癌以及癌症分化差的患者时，应采用传统手术。
