Merkel S, Hohenberger W, Hermanek P
Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland.
Chirurg. 2010 Aug;81(8):719-27. doi: 10.1007/s00104-010-1919-1.
The influence of surgical principles and neoadjuvant therapy on the frequency of local tumor cell dissemination (LTCD) in rectal carcinoma surgery and its consequences for local recurrence and survival rates were analyzed.
Data from the Erlangen registry for colorectal carcinomas (ERCRC) from 1969-2008 were compared with data from the literature published in 1980-2008.
LTCD was observed in 6.7% in the ERCRC (n=2764) and a frequency of 6.9% was reported in in the literature (n=13,395). In the course of time and especially since the introduction of total mesorectal excision (TME) surgery, the incidence of LTCD has significantly decreased. Neoadjuvant treatment did not influence the frequency of LTCD. Following LTCD the rate of local recurrence significantly increased and the 5 year survival rate significantly decreased. This also applied to patients with neoadjuvant therapy.
Even in the era of TME surgery attention must to be paid to avoidance of LTCD. It is obligatory to document the occurrence of LTCD and it must be taken into consideration in routine quality assurance. In cases of LTCD postoperative chemoradiation is indicated for patients without neoadjuvant irradiation.
分析手术原则和新辅助治疗对直肠癌手术中局部肿瘤细胞播散（LTCD）频率的影响及其对局部复发和生存率的影响。
将1969 - 2008年埃尔朗根结直肠癌登记处（ERCRC）的数据与1980 - 2008年发表的文献数据进行比较。
ERCRC中LTCD的发生率为6.7%（n = 2764），文献报道的发生率为6.9%（n = 13395）。随着时间推移，尤其是自全直肠系膜切除术（TME）开展以来，LTCD的发生率显著下降。新辅助治疗并未影响LTCD的频率。发生LTCD后，局部复发率显著增加，5年生存率显著降低。这同样适用于接受新辅助治疗的患者。
即使在TME手术时代，也必须注意避免LTCD。记录LTCD的发生情况是必要的，并且在常规质量保证中必须予以考虑。对于未接受新辅助放疗的LTCD患者，术后应进行放化疗。
