Peracchia A, Sarli L, Carreras F, Pietra N, Longinotti E, Gafà M
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università di Parma.
Ann Ital Chir. 1991 Jan-Feb;62(1):37-42; discussion 43-4.
This study explores the patterns of local recurrence after curative operations for colonic cancer. Over a 13 year period (1976-1988) 486 patients were operated on in the Surgical Clinic of Parma University for colonic cancer, but only 296 patients who underwent potentially curative resection were examined. The influence of patients' age, disease stage, site and grade, presence of obstruction or perforation and type of surgical procedures were examined as prognostic factors for local cancer recurrence. A total of 28 patients (14%) relapsed after surgery and 19 were found to have simultaneous distant metastasis. 86% of recurrences were evident within the first 2 years. Local recurrence rate increased with more advanced Duke's stage and stage of the primary tumour was most predictive for eventual relapse. The recurrences occurred within the operative resection site involving the anastomosis by inward growth at the suture line. Minute foci of adenocarcinoma not encompassed by the first operation might lead to local recurrences; the authors do not rule out, however, the rare possibility of the implantation of exfoliated malignant cells. Despite the attempt to carry out an intensive followup in terms of early diagnosis of recurrence in colonic surgery, the presence of local recurrences is associated with extremely poor prognosis independent of operative procedure performed. The authors believe that routine adjuvant radiation therapy after surgical treatment of locally advanced colonic cancer could improve survival rate.
本研究探讨了结肠癌根治性手术后局部复发的模式。在13年期间（1976 - 1988年），帕尔马大学外科诊所对486例结肠癌患者进行了手术，但仅对296例接受了潜在根治性切除术的患者进行了检查。研究了患者年龄、疾病分期、部位和分级、是否存在梗阻或穿孔以及手术方式等因素对局部癌症复发的预后影响。共有28例患者（14%）术后复发，其中19例发现同时存在远处转移。86%的复发在术后2年内出现。局部复发率随杜克分期的进展而增加，原发肿瘤分期对最终复发的预测性最强。复发发生在手术切除部位，通过缝线处向内生长累及吻合口。首次手术未切除的微小腺癌灶可能导致局部复发；然而，作者并不排除脱落的恶性细胞种植这种罕见可能性。尽管在结肠癌手术中试图对复发进行早期诊断并进行强化随访，但局部复发的存在与极差的预后相关，与所施行的手术方式无关。作者认为，对局部进展期结肠癌进行手术治疗后常规辅助放疗可提高生存率。
