Borschitz Thomas, Gockel Ines, Kiesslich Ralf, Junginger Theodor
Clinic of General and Abdominal Surgery, Johannes Gutenberg-University Hospital, Langenbeckstr. 1, 55131 Mainz, Germany.
Ann Surg Oncol. 2008 Nov;15(11):3101-8. doi: 10.1245/s10434-008-0113-x. Epub 2008 Aug 22.
Local excision (LE) of T1 rectal cancer yields low recurrence rates. However, more frequent recurrences with unknown states of high-risk T1/T2 tumors are risk factors. The purpose of this study was to evaluate if, after LE, immediate reoperation is required, or awaiting salvage surgery is sufficient.
150 T1 and 42 T2 tumors were treated by LE. Immediate reoperation was attempted for unfavorable pT1 (G3-4/L1/V1/R1/Rx/R < or =1 mm) and all pT2 tumors. Three groups were formed. Group A included low-risk pT1 tumors after complete (R0) LE; unfavorable pT1 and all T2 tumors were divided in groups B (immediate reoperation) and C (salvage surgery).
Groups A (n = 93) and B (n = 39) showed high tumor-free (TFS) and tumor-related survival (TRS) rates: group A 92% and 98%; group B 86% and 89%. In group C (n = 43), the TFS und TRS were significantly lower with 54% and 72%. Group A showed low recurrence rates and a wide range of International Union Against Cancer (UICC) stages. In group B, similarly low recurrence rates were found, but, in contrast, all recurrences were UICC IV. Group C had significantly higher recurrences rates and, in addition, two-thirds of these patients showed advanced UICC stages (III-IV).
LE of low-risk T1 tumors represents an adequate therapy. Immediate reoperation after LE of pT1 tumors with unfavorable histological finding or pT2 tumors can avoid local recurrences. Thereafter, high TFS rates can be expected in these patients, but metastases cannot be prevented and adjuvant measures are necessary. Awaiting recurrences as in group C leads to bad oncological outcomes with high recurrences and low survival rates.
T1期直肠癌的局部切除（LE）复发率较低。然而，高危T1/T2肿瘤状态不明时复发更为频繁是危险因素。本研究的目的是评估局部切除后是否需要立即再次手术，还是等待补救手术就足够了。
150例T1肿瘤和42例T2肿瘤接受了局部切除治疗。对预后不良的pT1（G3-4/L1/V1/R1/Rx/R≤1mm）和所有pT2肿瘤尝试立即再次手术。分为三组。A组包括完全（R0）局部切除后的低风险pT1肿瘤；预后不良的pT1和所有T2肿瘤分为B组（立即再次手术）和C组（补救手术）。
A组（n = 93）和B组（n = 39）显示出较高的无瘤生存率（TFS）和肿瘤相关生存率（TRS）：A组分别为92%和98%；B组分别为86%和89%。C组（n = 43）的TFS和TRS显著较低，分别为54%和72%。A组复发率低，国际抗癌联盟（UICC）分期范围广。B组同样复发率低，但相反，所有复发均为UICC IV期。C组复发率显著更高，此外，这些患者中有三分之二显示为晚期UICC分期（III-IV期）。
低风险T1肿瘤的局部切除代表了一种充分的治疗方法。pT1肿瘤组织学结果不良或pT2肿瘤局部切除后立即再次手术可避免局部复发。此后，这些患者有望获得较高的无瘤生存率，但无法预防转移，辅助措施是必要的。如C组那样等待复发会导致不良的肿瘤学结局，复发率高且生存率低。
