Cecchini Stefano, Azzoni Cinzia, Bottarelli Lorena, Marchesi Federico, Rubichi Francesco, Silini Enrico Maria, Roncoroni Luigi
Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100 Parma Italia..
Acta Biomed. 2017 Apr 28;88(1):39-44. doi: 10.23750/abm.v88i1.6031.
Many aspects of the surgical management of multiple sporadic colorectal cancer syndrome, either synchronous and metachronous, remain to be cleared, in particular the prognostic influence of the extent of surgical resection.
A retrospective review was performed of patients diagnosed with multiple colorectal cancer from 1982 to May 2010. Clinical and pathologic data were collected and reviewed. Survival analysis was performed.
We identified 23 patients with multiple sporadic colorectal cancers, of which 8 had synchronous (SC) and 15 metachronous cancers (MC). Of the MC patients, 2 (13%) had the second cancer within 2 years, 4 (27%) in the time period of 2-5 years and 9 (60%) after 5 years. Twenty-one patients underwent multiple segmental resections; 2 patients underwent subtotal colectomy. The 5-year overall survival rate of SC and MC patients was 100% and 87% (p<0.001) respectively. The 5-year overall survival rate of multiple segmental resection patients and subtotal colectomy was 94% and 75% (p=0.655) respectively.
Either synchronous and metachronous MSCRC patients showed good prognosis independently from to the extent of resection. Our results support a less aggressive biological behaviour allowing a more conservative management. Multiple segmental colorectal resections seem appropriate from an oncologic point of view in MSCRC patients.
多发散发性结直肠癌综合征的外科治疗，无论是同时性还是异时性的，在很多方面仍有待明确，尤其是手术切除范围对预后的影响。
对1982年至2010年5月期间诊断为多发结直肠癌的患者进行回顾性研究。收集并回顾临床和病理数据。进行生存分析。
我们确定了23例多发散发性结直肠癌患者，其中8例为同时性癌（SC），15例为异时性癌（MC）。在MC患者中，2例（13%）在2年内发生第二癌，4例（27%）在2至5年期间发生，9例（60%）在5年后发生。21例患者接受了多次节段性切除；2例患者接受了结肠次全切除术。SC和MC患者的5年总生存率分别为100%和87%（p<0.001）。多次节段性切除患者和结肠次全切除患者的5年总生存率分别为94%和75%（p=0.655）。
无论是同时性还是异时性的多发散发性结直肠癌患者，其预后均良好，与切除范围无关。我们的结果支持其生物学行为侵袭性较小，从而可以采取更保守的治疗。从肿瘤学角度来看，多次节段性结直肠切除术对多发散发性结直肠癌患者似乎是合适的。
