国际上直肠癌手术治疗的趋势。

International trends in surgical treatment of rectal cancer.

机构信息

Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.

出版信息

Am J Surg. 2011 Mar;201(3):353-7; discussion 357-8. doi: 10.1016/j.amjsurg.2010.08.030.

DOI:10.1016/j.amjsurg.2010.08.030

PMID:21367378

Abstract

BACKGROUND

Surgical technique might influence rectal cancer survival, yet international practices for surgical treatment of rectal cancer are poorly described.

METHODS

We performed a cross-sectional survey in a cohort of experienced colorectal surgeons representing 123 centers.

RESULTS

Seventy-one percent responded, 70% are from departments performing more than 50 proctectomies annually. More than 50% defined the rectum as "15 cm from the verge." Seventy-two percent perform laparoscopic proctectomy, 80% use oral bowel preparation, 69% perform high ligation of the inferior mesenteric artery, 76% divert stomas as routine for colo-anal anastomosis, and 63% use enhanced recovery protocols. Different practices exist between US and non-US surgeons: 15 cm from the verge to define the rectum (34% vs 59%; P = .03), personally perform laparoscopic resection (82% vs 66%; P = .05), rectal stump washout (36% vs 73%; P = .0001), always drain after surgery (23% vs 42%; P = .03), transanal endoscopic microsurgery for T2N0 in medically unfit patients (39% vs 61%; P = .0001).

CONCLUSIONS

Wide international variations in rectal cancer management make outcome comparisons challenging, and consensus development should be encouraged.

摘要

背景

手术技术可能会影响直肠癌的生存，但直肠癌的国际手术治疗实践情况描述较差。

方法

我们对代表 123 个中心的经验丰富的结直肠外科医生进行了横断面调查。

结果

71%的人做出了回应，其中 70%来自每年进行超过 50 例直肠切除术的科室。超过 50%的人将直肠定义为“距肛缘 15cm”。72%的人进行腹腔镜直肠切除术，80%的人使用口服肠道准备，69%的人进行肠系膜下动脉高位结扎，76%的人常规行结肠直肠吻合术转流造口，63%的人使用加速康复方案。美国和非美国外科医生之间存在不同的做法：以距肛缘 15cm 来定义直肠（34% vs 59%；P =.03），亲自进行腹腔镜切除（82% vs 66%；P =.05），直肠残端冲洗（36% vs 73%；P =.0001），术后始终引流（23% vs 42%；P =.03），不适合手术的患者经肛门内镜微创手术治疗 T2N0（39% vs 61%；P =.0001）。