Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2011 Apr;18(4):983-8. doi: 10.1245/s10434-010-1445-x. Epub 2010 Dec 14.
Retrorectal sarcomas are rare, and limited data are available on oncologic outcomes following surgery. Our aim was to evaluate outcomes in this patient population at our institution.
All patients who underwent surgical resection of a malignant retrorectal/presacral sarcoma between 1985 and 2005 were identified. Data analyzed included demographics, histopathologic diagnosis, surgical morbidity and mortality, use of adjuvant therapy, local and distant recurrence, and survival.
A total of 37 patients were identified (20 males) with a median age of 49 years (range, 22-81 years). The most common histopathologic diagnosis was malignant peripheral nerve sheath tumor (n = 8). Also, 22 tumors were high grade and 15 were low grade. Surgical margin status was R0 in 31 patients and R1 in 6. Adjuvant therapy was given to 26 patients. Postoperative morbidity and mortality was 57% and 3%, respectively. Median length of follow-up in 16 patients alive at last contact was 4.7 years. The 5-year survival free of local (LDFS), distant (DDFS), and local or distant recurrence (DFS) was 51, 58, and 39%, respectively. Patient survival at 2, 5, and 10 years was 75, 55, and 47%, respectively. Disease-free survival was not significantly associated with gender (P = .16), primary vs secondary (P = .94), R0 vs R1 resection (P = .26), low vs high tumor grade (P = .17), or the use of surgery with or without adjuvant therapy (P = .33).
Retrorectal sarcomas are often high grade and locally advanced. Most tumors are resectable with free margins, and long-term survival may be possible in up to one-half of patients following an aggressive surgical approach.
直肠后肉瘤较为罕见,有关其手术后的肿瘤学结果的数据有限。我们的目的是评估我院此类患者的预后。
回顾性分析 1985 年至 2005 年间手术切除的恶性直肠后/骶前肉瘤患者的临床资料。分析的数据包括患者的人口统计学特征、组织病理学诊断、手术并发症和死亡率、辅助治疗的应用、局部和远处复发以及生存情况。
共确定 37 例患者(20 例男性),中位年龄为 49 岁(范围 22-81 岁)。最常见的组织病理学诊断是恶性外周神经鞘瘤(n=8)。22 例肿瘤为高级别,15 例为低级别。31 例患者的手术切缘为 R0,6 例为 R1。26 例患者接受了辅助治疗。术后并发症发生率和死亡率分别为 57%和 3%。16 例生存患者的中位随访时间为 4.7 年。无局部复发(LDFS)、无远处转移(DDFS)和无局部或远处复发(DFS)的 5 年生存率分别为 51%、58%和 39%。2 年、5 年和 10 年的患者生存率分别为 75%、55%和 47%。疾病无进展生存率与性别(P=0.16)、原发性 vs 继发性(P=0.94)、R0 切除 vs R1 切除(P=0.26)、肿瘤低级别 vs 高级别(P=0.17)或手术联合或不联合辅助治疗(P=0.33)无关。
直肠后肉瘤通常为高级别且局部进展。大多数肿瘤可切除且切缘无肿瘤,采用积极的手术方法治疗后,多达一半的患者可能长期生存。