Kogler Pamela, Kafka-Ritsch Reinhold, Sieb Michael, Sztankay Arpad, Pratschke Johann, Zitt Matthias
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
J Gastrointest Surg. 2014 Nov;18(11):2026-33. doi: 10.1007/s11605-014-2633-y. Epub 2014 Aug 27.
Locoregional tumor recurrence after curative therapy for colorectal cancer is therapeutically challenging and associated with poor prognosis. Goal of this single-center study was to analyze patients with locoregional recurrence with regard to therapeutic strategies and outcome for colon and rectal cancer each. Charts of all patients surgically treated for colorectal cancer in the period from 2000 to 2011 (n = 1296) were examined; patients with locoregional recurrence (n = 86) were then further analyzed. Fifty-three (10.2%) patients with rectal and 33 (5.6%) patients with colon cancer developed a locoregional recurrence, median 24.5 months after first diagnosis. Recurrence-specific therapy was applied in the majority of the patients (84.8% colon, 90.7% rectum); a surgical approach was undertaken in 82.1% (colon) and in 56.3% (rectum). Five-year overall survival after locoregional recurrence was 13% for rectal cancer and 9% for colon cancer. Itemized analysis for the approached therapeutic regimens revealed that radical recurrence resection (R0) significantly prolongs overall survival (p = 0.003) in rectal cancer, as does a surgical approach itself, as compared to conservative treatment modalities. If feasible, oncologic radical resection of the relapse (R0) significantly influences patient outcome and overall survival in rectal cancer.
结直肠癌根治性治疗后局部区域肿瘤复发在治疗上具有挑战性，且预后较差。本单中心研究的目的是分析局部区域复发患者的结肠癌和直肠癌治疗策略及预后。研究检查了2000年至2011年期间接受手术治疗的所有结直肠癌患者的病历（n = 1296）；然后对局部区域复发患者（n = 86）进行进一步分析。53例（10.2%）直肠癌患者和33例（5.6%）结肠癌患者出现局部区域复发，首次诊断后中位复发时间为24.5个月。大多数患者（结肠癌84.8%，直肠癌90.7%）接受了复发特异性治疗；82.1%的结肠癌患者和56.3%的直肠癌患者采取了手术治疗。局部区域复发后直肠癌的5年总生存率为13%，结肠癌为9%。对所采用治疗方案的分项分析显示，与保守治疗方式相比，直肠癌根治性复发切除（R0）以及手术治疗本身均能显著延长总生存期（p = 0.003）。如果可行，对复发灶进行肿瘤根治性切除（R0）会显著影响直肠癌患者的预后和总生存期。
