Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 2013 Jun;56(6):711-6. doi: 10.1097/DCR.0b013e31827dbcb0.
Locally advanced, recurrent colorectal cancer involving the aortoiliac axis may be considered a contraindication for curative surgery because of the technical challenges of achieving a negative margin resection and an assumed poor prognosis.
The aim of this study was to assess oncologic outcomes and the ability to achieve an R0 resection in these patients.
A retrospective review of a prospectively maintained colorectal cancer database identified 406 consecutive patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007.
This study was conducted at an academic multidisciplinary tertiary center.
The demographic and clinicopathological features of patients undergoing resection for locally advanced disease involving the aortoiliac axis at our institution were reviewed.
Twelve patients (7 women, median age 51 years) were identified. Major vessel involvement included internal iliac artery (n = 7), common iliac artery (n = 5), external iliac artery (n = 3), aorta (n = 3), internal iliac vein (n = 2), and external iliac vein (n = 1). R0 resection was achieved in 7 patients, and R1 resection in 5. Eleven patients received intraoperative radiation therapy. Vascular reconstruction (3 aorta, 5 common iliac, 3 external iliac) included synthetic interposition grafts, femoral-femoral bypasses, or primary anastomosis. One patient underwent venous reconstruction of the external iliac vein. No graft complications were encountered, and graft patency at 4 years was 100%. Thirty-day morbidity was seen in 9 patients, 8 of whom had Clavien grade <3. Thirty-day mortality was nil. Overall and disease-free survival at 4 years was 55% and 45%.
This study was limited by its sample size, retrospective design, and the number of outcome events.
R0 resection of locally advanced recurrent colorectal cancer involving the aortoiliac axis was achieved in over 50% of patients. Overall and disease-free survival was comparable to outcomes seen with locally advanced disease to nonvascular structures.
局部晚期、复发性结直肠癌累及腹主动脉和髂总动脉可能被认为是根治性手术的禁忌症，因为实现阴性切缘切除术和预期预后不良存在技术挑战。
本研究旨在评估这些患者的肿瘤学结果和实现 R0 切除的能力。
对前瞻性维护的结直肠癌数据库进行回顾性分析，确定了 1997 年至 2007 年间在我们机构接受局部复发性结直肠癌手术的 406 例连续患者。
本研究在一家学术多学科三级中心进行。
我们机构对局部晚期累及腹主动脉和髂总动脉疾病行切除术的患者的人口统计学和临床病理特征进行了回顾。
确定了 12 例患者（7 名女性，中位年龄 51 岁）。主要血管受累包括髂内动脉（n=7）、髂总动脉（n=5）、髂外动脉（n=3）、主动脉（n=3）、髂内静脉（n=2）和髂外静脉（n=1）。7 例患者达到了 R0 切除，5 例患者达到了 R1 切除。11 例患者接受了术中放疗。血管重建（3 例主动脉、5 例髂总动脉、3 例髂外动脉）包括合成间置移植物、股-股旁路或直接吻合。1 例患者接受了髂外静脉的静脉重建。未发生移植物并发症，4 年时移植物通畅率为 100%。9 例患者出现 30 天并发症，其中 8 例患者为 Clavien 分级 <3。30 天死亡率为零。4 年总生存率和无病生存率分别为 55%和 45%。
本研究受到样本量、回顾性设计和结果事件数量的限制。
超过 50%的局部晚期复发性结直肠癌累及腹主动脉和髂总动脉的患者实现了 R0 切除。总生存率和无病生存率与非血管结构局部晚期疾病的结果相当。
