Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Colorectal Dis. 2012 Mar;14(3):e117-23. doi: 10.1111/j.1463-1318.2011.02804.x.
Whether reoperation in the postoperative period adversely affects oncologic outcomes for colorectal cancer patients undergoing resection has not been well characterized. The aim of this study was to determine whether long-term oncological outcomes are affected for patients who undergo repeat surgery in the early postoperative period.
From a prospective colorectal cancer database, patients who underwent resection for colorectal cancer between 1982 and 2008 and were reoperated within 30 days after surgery (group A) were matched for age (±5 years), gender, year of surgery (±2 years), American Society of Anesthesiology score, tumor site (colon or rectum), cancer stage and differentiation with patients who did not undergo reoperation (group B). The two groups were compared for overall survival (OS), disease-free survival (DFS) and local recurrence (LR).
In total, 89 reoperated patients (45 rectal, 44 colon cancer) were matched to an equal number of non-reoperated patients. Anterior resection (39.2%) and right hemicolectomy (19.1%) were predominant primary operations. Indications for reoperation were anastomotic leak/abscess (n=40, 45%), massive bleeding (n=15, 16.9%), bowel obstruction (n=11, 12.4%), wound complications (n=9, 10.1%) and other indications (n=14, 15.6%). Group A had significantly greater overall morbidity (100% vs 27%, P=0.001) and required more blood transfusions (20.2% vs 7.9%, P=0.045). Adjuvant therapy use, on the other hand, was more common in group B (23.6% vs 12.3%, P=0.1). The 5-year OS and DFS were lower in the reoperated group (OS 55.3% vs 66.4%, P=0.02; DFS 50.8% vs 60.8%, P=0.06, respectively). Five-year LR was slightly lower in the reoperated group (2.9% vs 6.3%, P=0.34).
Compared with non-reoperated patients matched for patient, tumour and operative characteristics, patients reoperated in the early postoperative period have worse long-term oncological outcomes. Adoption of strategies to reduce the risk of reoperation may be associated with the additional advantage of improved oncological outcomes in addition to the short-term advantages.
结直肠癌患者术后再次手术是否会对其肿瘤学结局产生不利影响尚不清楚。本研究旨在确定早期术后再次手术是否会影响患者的长期肿瘤学结局。
从前瞻性结直肠癌数据库中，选取 1982 年至 2008 年间接受结直肠癌切除术且术后 30 天内再次手术的患者（A 组），按年龄（±5 岁）、性别、手术年份（±2 年）、美国麻醉医师协会评分、肿瘤部位（结肠或直肠）、癌症分期和分化程度与未行再次手术的患者（B 组）进行匹配。比较两组患者的总生存率（OS）、无病生存率（DFS）和局部复发率（LR）。
共有 89 例再次手术患者（直肠 45 例，结肠癌 44 例）与同等数量的未再次手术患者相匹配。主要的初次手术方式为前切除术（39.2%）和右半结肠切除术（19.1%）。再次手术的指征为吻合口漏/脓肿（n=40，45%）、大出血（n=15，16.9%）、肠梗阻（n=11，12.4%）、伤口并发症（n=9，10.1%）和其他指征（n=14，15.6%）。A 组患者的总体并发症发生率显著更高（100% vs. 27%，P=0.001），需要输血的比例也更高（20.2% vs. 7.9%，P=0.045）。另一方面，B 组患者辅助治疗的使用率更高（23.6% vs. 12.3%，P=0.1）。再次手术组的 5 年 OS 和 DFS 较低（OS 55.3% vs. 66.4%，P=0.02；DFS 50.8% vs. 60.8%，P=0.06）。再次手术组的 5 年 LR 略低（2.9% vs. 6.3%，P=0.34）。
与在患者、肿瘤和手术特征方面相匹配但未再次手术的患者相比，早期再次手术的患者具有更差的长期肿瘤学结局。采用降低再次手术风险的策略可能除了具有短期优势外，还与改善肿瘤学结局有关。
