Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany.
Langenbecks Arch Surg. 2012 Oct;397(7):1059-67. doi: 10.1007/s00423-012-0975-z. Epub 2012 Jun 28.
Up to 20 % of colorectal cancer patients develop recurrent disease despite standardized surgical techniques and multimodal treatment strategies. Radical resection is the central component of curative therapy in these cases. The aim of this study was to evaluate treatment results in patients with locoregionally recurrent colorectal cancer.
From January 1995 to December 2007, surgery was performed for recurrent colorectal cancer in 82 patients who had undergone curative (R0) resection of their primary tumor. Assessment included patient, tumor and treatment characteristics, postoperative complications, and time without re-recurrence; recurrence-free and overall survival rates were calculated according to the Kaplan-Meier method.
Resection was performed in 60 of the 82 patients (73 %), repeat R0 resection in 52 % (31/60). Patients had a postoperative morbidity of 39 % (31/82), a relaparotomy rate of 13 % (11/82), and a lethality of 7 % (6/82). Forty-eight percent of all surgically-treated patients received a permanent stoma. Re-recurrence was seen in 52 % (16/31). R0 resection was associated with a 5-year survival rate of 35 % (11/31).
Extensive reinterventions often enable repeat R0 resection. Despite relevant morbidity, the lethality appears to be acceptable. Decisive for the prognosis is re-recurrence.
尽管采用了标准化的手术技术和多模式治疗策略，仍有 20%的结直肠癌患者会出现疾病复发。根治性切除术是这些患者治愈性治疗的核心组成部分。本研究旨在评估局部复发性结直肠癌患者的治疗结果。
1995 年 1 月至 2007 年 12 月，对 82 例接受过原发性肿瘤根治性（R0）切除术的复发性结直肠癌患者进行了手术治疗。评估内容包括患者、肿瘤和治疗特征、术后并发症以及无再复发时间；根据 Kaplan-Meier 法计算无复发生存率和总生存率。
82 例患者中有 60 例（73%）进行了切除术，其中 52%（31/60）进行了重复 R0 切除术。患者术后发病率为 39%（82/82），再次剖腹手术率为 13%（11/82），死亡率为 7%（6/82）。所有接受手术治疗的患者中有 48%接受了永久性造口术。31 例接受重复 R0 切除术的患者中有 52%（16/31）出现了再复发。R0 切除术的 5 年生存率为 35%（11/31）。
广泛的再次干预通常能够实现重复的 R0 切除术。尽管存在相关的发病率，但死亡率似乎是可以接受的。决定预后的是再复发。
