Department of Surgical Oncology, The Norwegian Radium Hospital, Oslo, Norway.
Colorectal Dis. 2011 May;13(5):506-11. doi: 10.1111/j.1463-1318.2010.02256.x.
This study investigated whether total mesorectal excision (TME), when carried out at the original operation for rectal cancer, influenced the effectiveness of subsequent salvage treatment for pelvic recurrence.
Between September 1990 and January 2006, 124 patients underwent radiotherapy and salvage surgery at the Norwegian Radium Hospital for locally recurrent rectal cancer without known distant metastases. Most of the primary operations had been performed at other hospitals: 62 patients had undergone a non-TME procedure (most operations in this group of patients were carried out before 1994); and 62 patients had undergone a TME procedure (all operations in this group of patients were carried out after 1992). In the TME group, 17 patients also received radiosensitizing chemotherapy.
A lower proportion of primary abdominoperineal resection and more sensitizing chemotherapy seemed to be to the advantage of the TME group, while a higher frequency of intra-operative radiotherapy might be beneficial in the non-TME group. The 5-year survival and R0 stage achievement were 30/24% and 44/40% for non-TME/TME groups. The local re-recurrence rates were nearly identical, at around 50%, for both groups. There was no change in R stage over time.
A primary operation which includes TME does not reduce the effectiveness of subsequent salvage treatment for locally recurrent rectal cancer.
本研究旨在探讨直肠癌初次手术行全直肠系膜切除术（TME）是否会影响盆腔复发后挽救性治疗的效果。
1990 年 9 月至 2006 年 1 月，124 例局部复发性直肠癌患者在挪威放射医院接受了放疗和挽救性手术，这些患者无远处转移。大多数原发手术是在其他医院进行的：62 例患者未行 TME 手术（该组大多数手术是在 1994 年前进行的）；62 例患者行 TME 手术（该组所有手术都是在 1992 年后进行的）。在 TME 组中，有 17 例患者还接受了增敏化疗。
初次腹会阴联合切除术比例较低且接受更多增敏化疗似乎对 TME 组有利，而术中放疗频率较高可能对非 TME 组有益。非 TME/TME 组的 5 年生存率和 R0 期实现率分别为 30/24%和 44/40%。两组局部复发率均接近 50%。R 期随时间无变化。
初次手术包括 TME 并不会降低局部复发性直肠癌后续挽救性治疗的效果。
