Singh Rajesh K, Dharmasena Dhanuson, Virgo Katherine S, Tyson Scott E, Grossmann Erik M, Johnson Frank E
Department of Surgery, Saint Louis University Medical Center, 3635 Vista Avenue, St. Louis, MO 63110-0250, USA.
Surg Oncol. 2008 Dec;17(4):313-6. doi: 10.1016/j.suronc.2008.05.007. Epub 2008 Jul 14.
Limited published information is available concerning the clinical course of spinal cord injured (SCI) patients who later develop rectal cancer and undergo proctectomy. We hypothesized that such patients would have poorer outcomes than comparable neurally-intact patients.
We conducted a retrospective study of all SCI veterans receiving care at all Department of Veterans Affairs (DVA) Medical Centers who subsequently underwent proctectomy for rectal cancer during fiscal years 1993-2002. Only patients with SCI due to trauma who met American Spinal Injury Association type A criteria (complete cord injury) were analyzed. The search strategy utilized DVA datasets plus data extracted from medical records.
There were 33,758 patients with ICD-9-CM diagnosis codes for SCI and 5246 patients with ICD-9-CM procedure codes for proctectomy due to rectal cancer; 72 patients were in both datasets. We received records for 72 patients and excluded 67 after chart review. Incorrect coding (44) and incomplete spinal cord lesions (9) were the most common exclusion criteria. Five patients were considered evaluable. The mean age at diagnosis was 65 (range 49-80). All five had symptomatic cancers and two (40%) had major comorbidities at admission. Postoperative complications occurred in four (80%). The winsorized mean length of stay was 28 days.
The complication rate and length of stay for SCI patients undergoing proctectomy for rectal cancer were higher than those reported for otherwise comparable neurally-intact patients. SCI should be considered a risk factor for adverse outcomes in operations for rectal cancer as in other major surgery.
关于脊髓损伤（SCI）患者后来罹患直肠癌并接受直肠切除术的临床病程，已发表的信息有限。我们推测，此类患者的预后要比神经功能正常的对照患者差。
我们对在所有退伍军人事务部（DVA）医疗中心接受治疗、并于1993 - 2002财政年度期间因直肠癌接受直肠切除术的所有SCI退伍军人进行了一项回顾性研究。仅分析因创伤导致SCI且符合美国脊髓损伤协会A型标准（完全性脊髓损伤）的患者。检索策略利用了DVA数据集以及从病历中提取的数据。
有33758例患者的ICD - 9 - CM诊断编码为SCI，5246例患者的ICD - 9 - CM手术编码为因直肠癌进行直肠切除术；72例患者同时出现在两个数据集中。我们获取了72例患者的病历，经病历审查后排除了67例。编码错误（44例）和脊髓损伤不完整（9例）是最常见的排除标准。5例患者被认为可进行评估。诊断时的平均年龄为65岁（范围49 - 80岁）。所有5例患者均患有有症状的癌症，2例（40%）入院时伴有严重合并症。4例（80%）发生了术后并发症。 Winsorized平均住院时间为28天。
因直肠癌接受直肠切除术的SCI患者的并发症发生率和住院时间高于神经功能正常的对照患者。与其他大型手术一样，SCI应被视为直肠癌手术不良预后的一个危险因素。
