Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Int J Surg. 2017 Dec;48:69-73. doi: 10.1016/j.ijsu.2017.09.069. Epub 2017 Oct 5.
Pelvic exenteration is the only radical treatment for locally advanced (ARC) or recurrent (RRC) rectal cancers. The long-term results of the procedure are variably reported in the literature, with recent series suggesting similar survival between ARC and RRC. The study aimed to analyze and compare the long-term survival and perioperative outcomes of patients undergoing pelvic exenteration for ARC and RRC in a tertiary center.
This was a retrospective analysis of prospectively collected data. Comparison of variables was performed using Chi-square, Fisher's exact or Wilcoxon rank sum test as appropriate. The Kaplan Meier method was used to analyze the disease-free survival (DFS) and the log-rank test to compare the two groups.
Since 2002, 46 patients underwent pelvic exenteration for ARC (28, 60.9%) and RRC (18, 39.1%). The groups had comparable characteristics, perioperative results, including postoperative complications, and rate of adjuvant chemotherapy. A R0 resection was obtained in 71.4% and 55.6% (p 0.41) and a T4 stage was diagnosed in 75% and 94.4% (p 0.22) of ARC and RRC patients, respectively. After a median follow-up time of 32.5 and 56.6 months (p 0.01), the 5-year DFS was significantly lower in the RRC group (23.6 vs 46.2%, p 0.006), even after exclusion of R1 cases (30 vs 54.5%, p 0.044).
The long-term disease free survival of patients undergoing pelvic exenteration is significantly worse when the procedure is performed for RRC, regardless of the tumor involvement of the resection margins.
盆腔廓清术是局部晚期（ARC）或复发性（RRC）直肠癌的唯一根治性治疗方法。该手术的长期结果在文献中有不同的报道，最近的系列研究表明 ARC 和 RRC 之间的生存情况相似。本研究旨在分析和比较在三级中心接受 ARC 和 RRC 盆腔廓清术的患者的长期生存和围手术期结果。
这是一项前瞻性收集数据的回顾性分析。使用卡方检验、Fisher 确切检验或 Wilcoxon 秩和检验比较变量。采用 Kaplan-Meier 法分析无病生存率（DFS），并采用对数秩检验比较两组。
自 2002 年以来，46 例患者接受了 ARC（28 例，60.9%）和 RRC（18 例，39.1%）的盆腔廓清术。两组具有可比性，包括术后并发症发生率和辅助化疗率在内的围手术期结果相似。ARC 和 RRC 患者的 R0 切除率分别为 71.4%和 55.6%（p=0.41），T4 期分别为 75%和 94.4%（p=0.22）。中位随访时间分别为 32.5 个月和 56.6 个月（p<0.01）后，RRC 组的 5 年 DFS 显著降低（23.6% vs. 46.2%，p=0.006），即使排除 R1 病例后（30% vs. 54.5%，p=0.044）也是如此。
无论切除边缘肿瘤累及情况如何，对 RRC 患者行盆腔廓清术的长期无病生存率显著降低。
