Cohen A M, Minsky B D
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Arch Surg. 1990 Feb;125(2):247-51. doi: 10.1001/archsurg.1990.01410140125020.
The purpose of this study was to explore the feasibility of sphincter preservation in abdominoperineal resection candidates by combining high-dose preoperative radiation therapy with restorative proctectomy through an endoanal anastomosis. Radiation to the pelvis was given using a three- or four-field technique to 4680 cGy (180 cGy/d) with portals from the top of S1 to 2 cm below the anus. The tumor bed received an additional 360-cGy boost. Four to 6 weeks after radiation therapy was completed, the patients underwent radical surgery. Phase I results for 14 patients are presented. All surgical specimens had negative distal and lateral margins. Surgical complications included one small-bowel obstruction requiring reoperation at 3 weeks, one pulmonary embolism, and one partial disruption (30% of the circumference) of the anastomosis. Bowel control and function were excellent in 8 and good in 4 patients. Function was not yet assessable in the remaining 2 patients.
本研究的目的是通过将高剂量术前放射治疗与经肛门吻合的保留直肠切除术相结合，探讨在腹会阴联合切除候选患者中保留括约肌的可行性。采用三野或四野技术对骨盆进行放疗，剂量为4680 cGy（180 cGy/天），照射野从S1顶部至肛门下方2 cm。肿瘤床额外接受360 cGy的追加照射。放疗结束4至6周后，患者接受根治性手术。本文报告了14例患者的I期结果。所有手术标本的远端和侧切缘均为阴性。手术并发症包括1例术后3周需再次手术的小肠梗阻、1例肺栓塞和1例吻合口部分裂开（周长的30%）。8例患者的肠道控制和功能良好，4例患者的情况尚可。其余2例患者的功能尚无法评估。
