Mañas M J, Espín E, López-Cano M, Vallribera F, Armengol-Carrasco M
Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Scand J Surg. 2015 Sep;104(3):154-60. doi: 10.1177/1457496914552341. Epub 2014 Sep 26.
To assess outcome in patients with locally advanced rectal cancer undergoing multivisceral resection.
Retrospective study of 30 consecutive patients (mean age 67.8 years) with primary locally advanced rectal cancer undergoing en bloc multivisceral resection of the organs involved with curative intent between 1998 and 2010. Overall survival, local and distal recurrence, and disease-free survival were analyzed by the Kaplan-Meier method. Risk factors for clinical outcome were obtained using a Cox multivariate model.
Postoperative complications occurred in 76.7% of patients and the in-hospital mortality rate was 10%. The median follow-up was 28.8 months. A total of 19 patients died at follow-up. Of the 11 patients who were alive, 7 were free of disease. In the multivariate analysis, lymph node involvement, stage II, and lymph vascular invasion were significantly associated with survival, and stage III showed a strong trend towards significance. Suture dehiscence (peritonitis and intra-abdominal abscess) showed a significant trend towards a higher local recurrence. Lymph vascular invasion was associated with a higher distant recurrence.
Lymph node involvement was associated with worse survival, whereas stage II and absence of lymph vascular invasion were associated with a better survival. Lymph vascular invasion was associated with a higher distant recurrence.
评估接受多脏器切除术的局部晚期直肠癌患者的预后。
对1998年至2010年间连续30例（平均年龄67.8岁）原发性局部晚期直肠癌患者进行回顾性研究，这些患者接受了整块多脏器切除术，切除涉及的器官，目的是根治性切除。采用Kaplan-Meier法分析总生存率、局部和远处复发率以及无病生存率。使用Cox多变量模型获得临床预后的危险因素。
76.7%的患者发生术后并发症，住院死亡率为10%。中位随访时间为28.8个月。共有19例患者在随访期间死亡。在11例存活患者中，7例无疾病。在多变量分析中，淋巴结受累、II期和淋巴管侵犯与生存率显著相关，III期显示出强烈的显著趋势。缝线裂开（腹膜炎和腹腔内脓肿）显示出局部复发率较高的显著趋势。淋巴管侵犯与远处复发率较高相关。
淋巴结受累与较差的生存率相关，而II期和无淋巴管侵犯与较好的生存率相关。淋巴管侵犯与较高的远处复发率相关。
