Department of Surgery, Division of General Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 2013 Jan;56(1):14-9. doi: 10.1097/DCR.0b013e3182741929.
A multimodality approach for locally recurrent colorectal cancer in the pelvis provides a significant survival advantage when negative margins are achieved. However, outcomes of surgical resection in patients who have locally re-recurrent disease in the pelvis are not well studied. Our aim was to assess the safety, feasibility of a negative margin resection, and survival outcomes in patients with pelvic locally re-recurrent colorectal cancer.
A retrospective review identified 406 patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. Patients who had locally re-recurrent disease in the pelvis who underwent curative-intent resection were identified.
Forty-seven patients (31 male) were identified. Median age was 57 years (range, 30-84 years). Median time to re-recurrence was 2.4 years (range, 0.5-5.6 years). Margin status following re-resection was R0 60%, R1 32%, and R2 8%. Nonbowel organs were resected en bloc in 81%, including 7 sacral resections. Intraoperative radiation was given to 77%. Morbidity occurred in 42%, with 6% requiring reoperation for complications. Thirty-day mortality was nil. Overall survival at 2 and 5 years was 83% and 33%. Disease-free survival at 2 and 5 years was 55% and 27%. Five-year survival for patients who had R0 and R1 resections was 37% and 42%, whereas no patients having an R2 resection survived beyond 2 years (p = 0.002).
In highly selected patients with re-recurrent colorectal cancer in the pelvis, we found that surgery could be performed safely and that a curative (R0) resection was possible in more than 50%. Two- and 5-year survival rates are comparable to results seen when surgery is done for first-time recurrences.
对于骨盆局部复发性结直肠癌，采用多模态方法可显著提高无瘤切缘时的生存优势。然而，对于骨盆局部再复发疾病患者进行手术切除的结果尚未得到很好的研究。我们的目的是评估在骨盆局部再发性结直肠癌患者中，安全、可行的阴性切缘切除以及生存结果。
回顾性分析于 1997 年至 2007 年间接受手术治疗局部复发性结直肠癌的 406 例患者。确定了在骨盆局部再复发疾病且接受根治性切除的患者。
共确定了 47 例患者（31 例男性）。中位年龄为 57 岁（范围，30-84 岁）。中位复发时间为 2.4 年（范围，0.5-5.6 年）。再次切除后的切缘状态为 R0 60%，R1 32%，R2 8%。81%的非肠道器官整块切除，包括 7 例骶骨切除。77%的患者术中给予了放疗。42%的患者发生了并发症，6%的患者需要再次手术治疗并发症。30 天死亡率为零。2 年和 5 年总生存率分别为 83%和 33%。2 年和 5 年无病生存率分别为 55%和 27%。R0 和 R1 切除患者的 5 年生存率分别为 37%和 42%，而 R2 切除患者无一例存活超过 2 年（p=0.002）。
在骨盆局部复发性结直肠癌的高度选择患者中，我们发现手术是安全的，超过 50%的患者可以进行根治性（R0）切除。2 年和 5 年的生存率与首次复发时手术的结果相当。
