Umpleby H C, Williamson R C
University Department of Surgery, Bristol Royal Infirmary, U.K.
Ann Acad Med Singap. 1987 Jul;16(3):456-61.
Eighty-five patients aged 40 or less who presented with colorectal carcinoma over a 32-year period were reviewed. The incidence was 2.5 per cent of all patients with large bowel cancer (n = 3426). Predisposing causes included familial polyposis (eight patients), panprotocolitis (ulcerative, one, Crohn's, one) and irradiation (one), four patients were pregnant, one-third of the patients presented as emergencies, and 43 per cent of these had intestinal obstruction. Five-year survival rates were 41 per cent overall and 59 per cent after "curative" resection. Survival was equivalent both for elective and emergency admission and for mucinous carcinomas (n = 16) and those non-mucinous carcinomas of moderate histological differentiation. Five-year survival rates were poorer when the history was less than three months in duration (20 per cent vs 45 per cent: P = 0.02) and for rectal and rectosigmoid tumours than colonic tumours (31 per cent vs 50 per cent: P = 0.05). Radical resection is indicated when feasible: four of five patients with involvement of adjacent viscera and four of six patients with resectable recurrence survived beyond 10 years. The outcome is similar to that at all ages, any unfavourable pathological features being balanced by improved survival following emergency operations.
回顾了32年间85例40岁及以下的结直肠癌患者。其发病率占所有大肠癌患者的2.5%（n = 3426）。易感因素包括家族性息肉病（8例）、全结肠炎（溃疡性结肠炎1例、克罗恩病1例）和放疗（1例），4例患者为孕妇，三分之一的患者为急诊就诊，其中43%有肠梗阻。总体五年生存率为41%，“根治性”切除后为59%。择期和急诊入院患者以及黏液腺癌（n = 16）和中度组织学分化的非黏液腺癌患者的生存率相当。病程小于3个月时五年生存率较差（20%对45%：P = 0.02），直肠和直肠乙状结肠肿瘤患者的五年生存率低于结肠肿瘤患者（31%对50%：P = 0.05）。可行时应进行根治性切除：5例累及相邻脏器的患者中有4例以及6例可切除复发病例中有4例存活超过10年。其结果与所有年龄段的情况相似，任何不利的病理特征都因急诊手术后生存率的提高而得到平衡。
