1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 2Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Dis Colon Rectum. 2014 Jan;57(1):47-55. doi: 10.1097/DCR.0000000000000015.
A multimodality approach to patients with locally recurrent rectal cancer that includes surgery is associated with a significant survival advantage when tumor-free margins are achieved. Patients with advanced tumors will require extended sacropelvic resection to optimize oncologic outcomes.
The aim of this study was to assess the safety, feasibility, and oncologic outcomes of extended sacropelvic resection for locally recurrent rectal cancer at our institution.
A retrospective review identified 406 patients who had surgery for locally recurrent rectal cancer between 1997 and 2007. From this group, all patients who underwent a curative-intent sacropelvic resection were analyzed.
This investigation was conducted at an academic tertiary referral center.
Thirty patients (24 male) were identified. Median age was 59 years (range, 25-84). Operations were performed for a first local recurrence (n = 24), a second recurrence (n = 5) and for a third recurrence (n = 1).
Twenty-six patients underwent neoadjuvant radiation, and 20 received intraoperative radiation therapy. All patients underwent extended sacropelvic resection.
The primary outcomes measured were early (<30 days) and late (>30 days) surgical complications. Overall and disease-free survivals were estimated by using the Kaplan-Meier technique.
Margin-negative resection was achieved in 93%. The most proximal level of spinal transection was the fourth lumbar space, and 4 patients underwent lower extremity amputation. There was no mortality, and early morbidity was seen in 76%. Median follow-up was 2.7 years (range, 2 months to 10.8 years). Overall survival at 2 and 5 years was 86% and 46%. Disease-free survival at 2 and 5 years was 79% and 43%.
This study was limited by its retrospective nature and the limited number of patients.
We found extended sacropelvic resection for locally recurrent rectal cancer to be feasible and safe with overall and disease-free survival rates in comparison with survival rates seen in patients undergoing nonsacropelvic resections for locally recurrent rectal cancer.
对于局部复发性直肠癌患者，采用包括手术在内的多模态方法，当达到无肿瘤切缘时，与显著的生存优势相关。对于晚期肿瘤患者，需要进行广泛的盆骶切除术，以优化肿瘤学结果。
本研究旨在评估我院局部复发性直肠癌患者进行广泛盆骶切除术的安全性、可行性和肿瘤学结果。
回顾性分析了 1997 年至 2007 年间接受手术治疗的 406 例局部复发性直肠癌患者。在此组中，对所有接受根治性盆骶切除术的患者进行了分析。
本研究在一家学术性三级转诊中心进行。
共确定 30 例患者（24 例男性）。中位年龄为 59 岁（范围，25-84 岁）。手术治疗原因包括首次局部复发（n=24）、第二次复发（n=5）和第三次复发（n=1）。
26 例患者接受了新辅助放疗，20 例患者接受了术中放疗。所有患者均接受了广泛的盆骶切除术。
主要观察的早期（<30 天）和晚期（>30 天）手术并发症。通过 Kaplan-Meier 技术估计总生存率和无病生存率。
切缘阴性切除率为 93%。最接近的脊柱横断水平为第四腰椎，4 例患者行下肢截肢。无死亡病例，早期并发症发生率为 76%。中位随访时间为 2.7 年（范围，2 个月至 10.8 年）。2 年和 5 年总生存率分别为 86%和 46%。2 年和 5 年无病生存率分别为 79%和 43%。
本研究受到回顾性研究和患者数量有限的限制。
我们发现，对于局部复发性直肠癌患者，进行广泛的盆骶切除术是可行和安全的，与未行盆骶切除术的局部复发性直肠癌患者的总生存率和无病生存率相当。
