Crawshaw Benjamin P, Augestad Knut M, Keller Deborah S, Nobel Tamar, Swendseid Brian, Champagne Bradley J, Stein Sharon L, Delaney Conor P, Reynolds Harry L
Department of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Department of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Am J Surg. 2015 Mar;209(3):526-31. doi: 10.1016/j.amjsurg.2014.10.014. Epub 2014 Dec 17.
Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated.
A retrospective review was conducted of patients who underwent multivisceral resection for locally advanced rectal cancer with and without sphincter preservation.
Sixty-one patients underwent multivisceral resection for rectal cancer from 2005 to 2013 with a median follow-up of 27.8 months. Five-year overall and disease-free survival were 49.2% and 45.3%, respectively. Thirty-four patients (55.7%) had sphincter-sparing operations with primary coloanal anastomosis and temporary stoma. There was no significant difference in overall or disease-free survival, or recurrence with sphincter preservation compared with those with permanent stoma.
Multivisceral resection for locally advanced rectal cancer has acceptable oncologic and clinical outcomes. Sphincter preservation and subsequent reestablishment of gastrointestinal continuity does not impact oncologic outcomes and should be considered in many patients.
局部晚期直肠癌的治疗通常需要进行多脏器切除。此类手术相对少见，而且肿瘤学结局，尤其是在进行保肛手术时，尚未得到充分证实。
对接受多脏器切除的局部晚期直肠癌患者进行回顾性研究，这些患者中有保肛的，也有未保肛的。
2005年至2013年期间，61例患者接受了直肠癌多脏器切除，中位随访时间为27.8个月。5年总生存率和无病生存率分别为49.2%和45.3%。34例患者（55.7%）接受了保留括约肌的手术，采用一期结肠肛管吻合术和临时造口。与永久性造口患者相比，保肛患者的总生存率、无病生存率或复发率均无显著差异。
局部晚期直肠癌的多脏器切除具有可接受的肿瘤学和临床结局。保留括约肌及随后重建胃肠道连续性并不影响肿瘤学结局，许多患者都应考虑这一术式。
