Campos Fábio Guilherme, Calijuri-Hamra Maria Célia, Imperiale Antonio Rocco, Kiss Desidério Roberto, Nahas Sergio Carlos, Cecconello Ivan
Unidade Colorretal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
Arq Gastroenterol. 2011 Oct-Dec;48(4):270-5. doi: 10.1590/s0004-28032011000400010.
To evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer.
Cohort study including 679 colorectal cancer patients treated from 1997 to 2007. Clinical, surgical and histological data were analyzed.
Ninety patients (females 61%; median age 59 years) were treated for locally advanced carcinomas (13.2%), either in the colon (66%) or rectum (34%). Extended resections most commonly involved the small bowel (19.8%), bladder (16.4%), uterus (12.9%) and ovaries (11.2%). Postoperative morbidity and mortality occurred in 23 (25.6%) and 3 (3.3%) patients, respectively. Survival and recurrence analysis among 76 R0 (84.4%) procedures revealed a 60% 5-year survival and 34% local recurrence rates. Survival curves demonstrated reduced rates for rectal location (45% vs 65%), tumor depth (50% for T4 vs 75% for T3), vascular/ lymphatic/perineural invasion (35% vs 80%) and lymph node metastasis (35% vs 80%).
Locally advanced carcinomas were found in 13.2% of patients. Survival rates were negatively affected by rectal location and adverse histological features. Number of involved organs and neoplastic adhesions did not influenced chances of survival. A radical R0 extended resection was achieved in a high proportion of cases, resulting in a 60% cancer-free survival under acceptable operative risks.
评估局部进展期结直肠癌的发病率、手术结果及预后因素。
队列研究纳入了1997年至2007年接受治疗的679例结直肠癌患者。对临床、手术及组织学数据进行分析。
90例患者（女性占61%；中位年龄59岁）接受了局部进展期癌的治疗（占13.2%），其中结肠癌患者占66%，直肠癌患者占34%。扩大切除术最常涉及小肠（19.8%）、膀胱（16.4%）、子宫（12.9%）和卵巢（11.2%）。术后并发症和死亡率分别发生在23例（25.6%）和3例（3.3%）患者中。对76例R0（84.4%）手术的生存和复发分析显示，5年生存率为60%，局部复发率为34%。生存曲线显示，直肠癌部位（45%对65%）、肿瘤深度（T4为50%对T3为75%）、血管/淋巴管/神经周围侵犯（35%对80%）和淋巴结转移（35%对80%）患者的生存率降低。
13.2%的患者患有局部进展期癌。生存率受到直肠癌部位和不良组织学特征的负面影响。受累器官数量和肿瘤粘连情况不影响生存机会。在高比例的病例中实现了根治性R0扩大切除术，在可接受的手术风险下实现了60%的无癌生存率。
