Itah Refael, Greenberg Ron, Werbin Nachum, Sacham-Shmueli Einat, Inbar Roy, Avital Shmuel
Department of Surgery A, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Isr Med Assoc J. 2011 May;13(5):300-3.
Major changes in the evaluation and treatment of curable colorectal cancer (CRC) have emerged in the last two decades. These changes have led to better patient outcome overtime.
To evaluate the impact of these changes as reflected in the difference in long-term outcome of a consecutive group of recently laparoscopically operated curable CRC patients and a consecutive group of patients operated 20 years earlier in the same department.
Data of the new group were taken from our prospectively collected data of patients who underwent elective laparoscopic surgery for CRC in recent years. Data regarding patients operated on 20 years ago were retrieved from previous prospectively collected data on the long-term survival of CRC patients operated in the same department.
The recently operated group comprised 203 patients and the previous group 199 patients. Perioperative mortality was 0.5% in the new group versus 1.5% in the old group (not significant). There were more early-stage and more proximal tumors in the recently operated group. A Kaplan-Meier 5-year survival analysis revealed no difference between stage I patients of the two groups. However, there was a significant increase in 5-year survival in the new group for stage II (85% vs. 63%, P = 0.004) and for stage III patients (57% vs. 39%, P = 0.01). This trend was maintained after removing the rectal cancer patients from the calculated data.
We have demonstrated improved survival for stage II and ILL CRC patients overa 20-year period in the same medical center. This change most likely reflects advances both in imaging techniques leading to more accurate staging and in adjuvant treatments.
在过去二十年中，可治愈性结直肠癌（CRC）的评估和治疗出现了重大变化。随着时间的推移，这些变化使患者预后更佳。
通过比较同一科室近期接受腹腔镜手术的一组可治愈性CRC患者与20年前接受手术的一组患者的长期预后差异，评估这些变化的影响。
新组患者的数据来自我们近年来前瞻性收集的接受择期腹腔镜CRC手术患者的数据。20年前接受手术患者的数据则从同一科室之前前瞻性收集的CRC手术患者长期生存数据中获取。
近期手术组有203例患者，之前的组有199例患者。新组围手术期死亡率为0.5%，旧组为1.5%（无显著差异）。近期手术组中早期肿瘤和近端肿瘤更多。Kaplan-Meier 5年生存分析显示，两组I期患者之间无差异。然而，新组II期患者（85%对63%，P = 0.004）和III期患者（57%对39%，P = 0.01）的5年生存率显著提高。在计算数据中剔除直肠癌患者后，这一趋势依然存在。
我们证明了在同一医疗中心，20年间II期和III期CRC患者的生存率有所提高。这种变化很可能反映了成像技术的进步（从而实现更准确的分期）以及辅助治疗的进步。
