Department of Digestive Surgery, Purpan University Hospital, 1, place Baylac, 31000 Toulouse, France.
J Visc Surg. 2013 Apr;150(2):97-107. doi: 10.1016/j.jviscsurg.2013.03.007. Epub 2013 Apr 23.
Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially with suboptimal surgery (non-TME). For numerous patients, diagnosis of LR is done at late stage of the disease because of the high rate of asymptomatic patients. MRI and PET-scan are the most performing exams to assess the local and general extension, with high diagnostic accuracy (sensibility 85% and specificity 92%). For extraluminal pelvic recurrences from rectal cancer, pelvic exenterations alone or with irradiation (preoperative and/or intraoperative) can afford a R0 resection rate ranging from 30% to 45% with acceptable morbidity. Morbidity and mortality rates are high for total exenteration and abdominosacral resection. After curative surgery, 5-year global survival from 30% to 40% is observed. Careful selection of patients with better preoperative status before resection is needed to achieve more curative resections and increase long-term survivor rates.
直肠癌根治术后局部复发（LR）的发生率为 4%至 33%，尤其是手术非完全系膜切除术（TME）者。由于无症状患者比例较高，许多患者在疾病晚期才被诊断出 LR。MRI 和 PET 扫描是评估局部和全身扩展的最有效检查，具有较高的诊断准确性（敏感性 85%，特异性 92%）。对于直肠癌的盆外盆腔复发，单独进行盆脏清除术或联合放疗（术前和/或术中）可以实现 R0 切除率，范围为 30%至 45%，且发病率可接受。全盆脏清除术和腹会阴切除术的发病率和死亡率较高。根治性手术后，5 年总生存率为 30%至 40%。在进行切除术前，需要仔细选择术前状态较好的患者，以实现更具治愈性的切除，并提高长期生存率。
