Belli Filiberto, Gronchi Alessandro, Corbellini Carlo, Milione Massimo, Leo Ermanno
Filiberto Belli, Carlo Corbellini, Ermanno Leo, Colorectal Surgery Unit, National Cancer Institute, 20133 Milan, Italy.
World J Gastrointest Surg. 2016 Dec 27;8(12):770-778. doi: 10.4240/wjgs.v8.i12.770.
To investigate feasibility and outcome of abdominal-sacral resection for treatment of locally recurrent rectal adenocarcinoma.
A population of patients who underwent an abdominal-sacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.
At the time of abdomino-sacral resection, the mean age of patients was 55 (range, 38-64). The median operating time was 380 min (range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 mL (range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type II complication according to the Clavien-Dindo classification. Microscopically negative margins (R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a median survival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.
Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.
探讨腹骶部切除术治疗局部复发性直肠腺癌的可行性及疗效。
研究对象为2005年至2013年间在米兰国家癌症研究所接受腹骶部切除术治疗直肠后复发腺癌的患者群体。回顾性收集的数据包括患者特征、原发性和复发性直肠肿瘤手术切除的治疗及病理细节。进行了临床和仪器随访。调查了手术和肿瘤学疗效。此外，还对文献进行了分析性综述，以便将我们的病例系列与其他报道的经验进行比较。
在进行腹骶部切除术时，患者的平均年龄为55岁（范围38 - 64岁）。中位手术时间为380分钟（范围270 - 480分钟）。3例患者在S2/S3水平进行骶骨切除，3例患者在S3/S4水平，4例患者在S4/S5水平。中位手术时间为380±58分钟。平均术中失血量为1750毫升（范围200 - 680毫升）。中位住院时间为22天。总体并发症发生率为80%，主要为Clavien-Dindo分类中的II型并发症。所有患者均获得显微镜下切缘阴性（R0）。首次手术后总体5年生存率为60%，首次手术后的中位生存期为88±56个月。再次复发最常见的部位是盆腔内。
骶骨切除是治疗无远处转移证据的直肠后部癌症复发的一种可行方法。准确分期对于规划最佳治疗至关重要。
