Laurence Graham, Ahuja Vanita, Bell Ted, Grim Rod, Ahuja Nita
York Hospital, York, ME, USA.
York Hospital, York, ME, USA.
Am J Surg. 2017 Sep;214(3):432-436. doi: 10.1016/j.amjsurg.2016.12.018. Epub 2016 Dec 28.
Multivisceral resection (MVR) is considered a radical operation with many surgeons only using it as a last resort. However, when locally advanced colorectal cancers invade adjacent organs, MVR is an important consideration for select patients. The current study addresses the outcomes of MVR in locally advanced recto-sigmoid cancer patients subsequent to these recommendations and hypothesizes that MVR yields improved survival.
SEER data (1988-2008) was used to identify all eligible patients with MVR. Patients were limited to single primary locally advanced non-metastatic colorectal cancers originating from the sigmoid and rectum.
A total of 4111 locally advanced non-metastatic recto sigmoid cancer patients were included in the study. Cox regression analysis showed variables predictive of MVR were female (OR = 1.95) and late year period (OR = 1.90). Kaplan Meier analysis showed that five-year survival was highest for MVR (52.7%, 48 months), followed by standard surgery (SS; 38.9%, 32 months) and no surgery (NS; 16.6%, 12 months, P < 0.001). With radiation treatment, five year survival improved for all groups, with the highest being MVR (57%, 52 months). With no radiation treatment, five year survival decreased for all groups, with the highest being MVR (45.1%, 44 months), followed by SS (27.3%, 19 months), and NS (8.7%, 6 months, P < 0.001).
The present study supports that MVR offers greater survival advantage in patients with locally advanced colorectal cancer. MVR are extensive surgical procedures with significant associated morbidity that usually require specialized training and sometimes the coordination of multiple surgical specialists.
多脏器切除术（MVR）被认为是一种根治性手术，许多外科医生仅在万不得已时才使用。然而，当局部晚期结直肠癌侵犯相邻器官时，对于部分患者而言，MVR是一个重要的考量方案。本研究探讨了遵循这些建议后局部晚期乙状结肠直肠癌患者接受MVR的疗效，并假设MVR能提高生存率。
利用监测、流行病学与最终结果（SEER）数据库（1988 - 2008年）来确定所有符合条件的接受MVR的患者。患者仅限于源于乙状结肠和直肠的单一原发性局部晚期非转移性结直肠癌。
本研究共纳入4111例局部晚期非转移性乙状结肠直肠癌患者。Cox回归分析显示，女性（比值比[OR]=1.95）和较晚年份（OR = 1.90）是MVR的预测变量。Kaplan - Meier分析表明，MVR患者的五年生存率最高（52.7%，48个月），其次是标准手术（SS；38.9%，32个月）和未手术（NS；16.6%，12个月，P<0.001）。接受放疗后，所有组的五年生存率均有所提高，其中MVR组最高（57%，52个月）。未接受放疗时，所有组的五年生存率均下降，其中MVR组最高（45.1%，44个月），其次是SS组（27.3%，19个月）和NS组（8.7%，6个月，P<0.001）。
本研究支持MVR为局部晚期结直肠癌患者提供更大的生存优势。MVR是广泛的外科手术，具有显著的相关发病率，通常需要专门培训，有时还需要多个外科专家的协作。
