盆腔廓清术治疗局部晚期原发性和复发性直肠癌的适应证和结果。

Indications and outcome of pelvic exenteration for locally advanced primary and recurrent rectal cancer.

机构信息

*Department of Colorectal Surgery, the Royal Marsden Hospital, London †Division of Surgery, Chelsea and Westminster Campus, Imperial College London, London ‡Department of Radiology, the Royal Marsden Hospital, London; and §Division of Surgery, Imperial College, St Mary's Hospital, London.

出版信息

Ann Surg. 2014 Feb;259(2):315-22. doi: 10.1097/SLA.0b013e31828a0d22.

DOI:10.1097/SLA.0b013e31828a0d22

PMID:23478530

Abstract

OBJECTIVE

The outcome of pelvic exenteration was compared in patients with locally advanced primary (LAP) cancer and recurrent rectal cancer (RRC).

BACKGROUND

There are few reports comparing the results of pelvic exenteration for primary advanced rectal cancer and RRC.

METHODS

Consecutive patients undergoing pelvic exenteration between 2006 and 2011 were identified from a prospectively maintained database. The main endpoints were 3-year disease-free survival (DFS) and local recurrence-free survival (LRFS).

RESULTS

Of 100 exenterative operations, 55 were for LAP cancer and 45 for RRC. Exenteration of 1 pelvic compartment was required in 30 cases, 2 compartments in 49 cases, and 3 of 4 compartments in 21 cases. R0, R1, and R2 resections were achieved in 78, 15, and 7 cases, respectively. R0 rates were significantly higher in LAP cancer than in RRC (91% vs 62%, P = 0.001). Three-year DFS for R0, R1, and R2 resections was 67%, 49%, and 0%, respectively (P < 0.001). For R0 resections only, DFS in LAP cancer was 76% and 57% in RRC (P = 0.212). On multivariate analysis, a positive resection margin (hazard ratio, 4.04; P < 0.001) and positive lymph node staging (hazard ratio, 2.43; P = 0.022) were significant predictors of reduced DFS. Three-year LRFS for R0 resection was 86% for LAP cancer and 84% for RRC (P = 0.817). On multivariate analysis, only a positive resection margin was a significant predictor of reduced LRFS (hazard ratio, 5.48; P = 0.002).

CONCLUSIONS

Resection margin status is more important than primary or recurrent cancer in predicting long-term outcome.

摘要

目的

比较局部晚期原发性（LAP）癌症和复发性直肠癌（RRC）患者行盆腔廓清术的结果。

背景

比较原发性晚期直肠癌和 RRC 患者行盆腔廓清术结果的报道较少。

方法

从一个前瞻性维护的数据库中确定了 2006 年至 2011 年间接受盆腔廓清术的连续患者。主要终点是 3 年无病生存率（DFS）和局部无复发生存率（LRFS）。

结果

100 例廓清手术中，55 例为 LAP 癌，45 例为 RRC。30 例需要 1 个盆腔间隙廓清，49 例需要 2 个间隙廓清，21 例需要 3 个或 4 个间隙廓清。R0、R1 和 R2 切除分别达到 78、15 和 7 例。R0 切除率在 LAP 癌中明显高于 RRC（91% vs 62%，P = 0.001）。R0、R1 和 R2 切除的 3 年 DFS 分别为 67%、49%和 0%（P < 0.001）。仅行 R0 切除时，LAP 癌的 DFS 为 76%，RRC 为 57%（P = 0.212）。多变量分析显示，阳性切缘（风险比，4.04；P < 0.001）和阳性淋巴结分期（风险比，2.43；P = 0.022）是降低 DFS 的显著预测因素。R0 切除的 3 年 LRFS 分别为 LAP 癌的 86%和 RRC 的 84%（P = 0.817）。多变量分析显示，仅阳性切缘是降低 LRFS 的显著预测因素（风险比，5.48；P = 0.002）。