Slisow W, Möhner M
Zentralinistitut für Krebsforschung, Akademie der Wissenschaften der DDR, Robert-Rössle-Institut, Berlin.
Zentralbl Chir. 1990;115(7):399-406.
From the rectum carcinoma cases diagnosed and reported to the National Cancer Registry in 1980, 886 were submitted to obduction. Metastases were detected in 46.8% of the autopsy material. Affected were the liver in 38.7%, the lung in 16.1%, and the skeleton in 3.5% of the obducted cases. The pattern of metastases depended on the histological picture of the carcinoma: with adenocarcinomas, haematogenic metastases, and with mucigenic adenocarcinomas, lymphogenic metastases were predominant; the signet-ring-cell carcinomas develop their pronounced metastatic potency in either way. The isolated liver affection could be established in 9% of all liver metastatic patients who underwent radical operation, and in 22% following exclusion of a presacral recurrence, respectively. A histologically oriented scheme is proposed to complete the spreading diagnostics and to establish a therapeutic concept for liver metastases, and an additional, targeted, systematic intraperitoneal and endolymphatic application of cytostatic substances in the treatment of liver metastases to reduce the extrahepatic metastatic rate is discussed.
从1980年诊断并上报至国家癌症登记处的直肠癌病例中，选取了886例进行尸检。在46.8%的尸检材料中检测到转移情况。在接受尸检的病例中，38.7%的患者肝脏受累，16.1%的患者肺部受累，3.5%的患者骨骼受累。转移模式取决于癌的组织学表现：腺癌以血行转移为主，黏液性腺癌以淋巴转移为主；印戒细胞癌两种转移方式的转移能力均较强。在所有接受根治性手术的肝转移患者中，分别有9%和排除骶前复发后22%的患者出现孤立性肝脏受累。提出了一种基于组织学的方案，以完善扩散诊断并确立肝转移的治疗理念，并讨论了在肝转移治疗中额外、有针对性、系统性地腹腔内和淋巴管内应用细胞毒性物质以降低肝外转移率的问题。
