Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Surgery. 2012 Feb;151(2):238-44. doi: 10.1016/j.surg.2010.10.018. Epub 2010 Dec 22.
So far, few reports have focused on the clinicopathological features and patterns of recurrence after a complete resection of peritoneal carcinomatosis (PC) of colorectal origin. The purpose of the present study was to show the clinicopathological features of a macroscopically complete resected tumor and the pattern of recurrence after the curative resection of colorectal PC.
In 153 patients with colorectal PC, 31 patients who underwent a complete resection of a synchronous primary lesion of a colorectal PC between 1998 and 2007 were assessed retrospectively.
Clinicopathological differences were observed in the tumor location, presence of extraperitoneal metastases, extent of PC, and presence of lymph node metastases between a macroscopically complete resection and noncomplete resection patients (P = .045, P < .0001, P < .001, and P = .039, respectively). Tumor recurrence after the complete resection of colorectal PC was observed in 24 patients (77.4%). The 5-year survival rate after complete resection was 36.0%. The survival rate in the macroscopically complete resection group was higher than in the incomplete resection group (P < .001). The 5-year intra- and extraperitoneal recurrence survival rates were 63.9% and 33.8%, respectively. No significant clinicopathological factors affected intraperitoneal recurrence-free survival. Conversely, a univariate analysis using the log-rank test revealed that extended PC and presence of lymph node metastases were poor factors affecting extraperitoneal recurrence (P = .009 and P = .023, respectively). Eleven of 31 patients survived for 5 years after resection. Two of the 4 patients with liver metastases had received a hepatectomy.
Although the 5-year survival rate after a macroscopically complete resection for colorectal PC approached 36.0%, 77.4% of patients developed intra- and extraperitoneal recurrence. Extended PC and presence of lymph node metastases were poor factors affecting extraperitoneal recurrence.
目前，鲜有研究报道完整切除结直肠来源腹膜转移瘤（peritoneal carcinomatosis，PC）后的临床病理特征和复发模式。本研究旨在展示结直肠 PC 根治性切除术后大体完全切除肿瘤的临床病理特征和复发模式。
回顾性分析 1998 年至 2007 年间行结直肠 PC 同步原发灶完全切除术的 31 例患者。
在宏观完全切除和非完全切除患者中，肿瘤位置、有无腹膜外转移、PC 程度和有无淋巴结转移存在差异（P =.045，P <.0001，P <.001，P =.039）。24 例患者（77.4%）在结直肠 PC 完全切除术后出现肿瘤复发。完全切除后的 5 年生存率为 36.0%。宏观完全切除组的生存率高于非完全切除组（P <.001）。5 年内腹膜内和腹膜外复发的生存率分别为 63.9%和 33.8%。无明显临床病理因素影响腹膜内无复发生存率。相反，单因素分析显示，广泛的 PC 和淋巴结转移是影响腹膜外复发的不良因素（P =.009 和 P =.023）。31 例患者中有 11 例在切除后存活 5 年。4 例肝转移患者中有 2 例接受了肝切除术。
虽然结直肠 PC 宏观完全切除术后 5 年生存率接近 36.0%，但 77.4%的患者发生腹膜内和腹膜外复发。广泛的 PC 和淋巴结转移是影响腹膜外复发的不良因素。
