Xanthis A, Greenberg D, Jha B, Olafimihan O, Miller R, Fearnhead N, Davies J, Hall N
Colorectal Unit, Addenbrooke's Hospital , Cambridge , UK.
Public Health England, National Cancer Registration and Analysis Service, Fulbourn , Cambridge , UK.
Ann R Coll Surg Engl. 2018 Feb;100(2):111-115. doi: 10.1308/rcsann.2017.0161. Epub 2017 Sep 15.
Introduction Low rectal cancers requiring abdominoperineal resection tend to have a worse prognosis than higher tumours, which may be treated by anterior resection. One of the reasons for this may be inadequate local surgery, in particular the narrow waist of the resection specimen of a standard abdominoperineal resection may be associated with a high positive circumferential resection margin. The extralevator abdominoperineal excision (ELAPE) aims to improve the R0 resection rate but carries significant morbidity. We examined our own results of standard abdominoperineal resection to assess the need for a change of policy. Methods We operformed a retrospective analysis of consecutive standard abdominoperineal resections for rectal cancer in a single centre from June 2002 to December 2011. Results A total of 102 patients underwent standard abdominoperineal resection with curative intent; 19 had no preoperative treatment, 42 had short course radiotherapy, 9 had long course radiotherapy and 32 had neoadjuvant chemotherapy followed by long course chemoradiotherapy. In 17/102(16.6%), there was a positive circumferential resection margin. Over a median follow up of 32 months, 20 patients developed recurrence of any type. Local recurrence occurred in five patients (two of which also had distant recurrence), of whom two had a positive circumferential resection margin (P = 0.10). Actuarial two-year local only recurrence was 3.4% and any recurrence was 17.7%. Overall five-year cancer specific survival was 77%. Conclusions In this series we found low rates of local recurrence after standard abdominoperineal resection even with a circumferential margin rate positivity of 16.6%.Performing an ELAPE in selected cases may improve these results further but is not necessarily required for all patients.
引言
需要腹会阴联合切除术的低位直肠癌预后往往比高位肿瘤更差，高位肿瘤可通过前切除术治疗。造成这种情况的原因之一可能是局部手术不充分，特别是标准腹会阴联合切除术切除标本的腰部狭窄可能与高环周切缘阳性率相关。经肛提肌外腹会阴切除术（ELAPE）旨在提高R0切除率，但会带来较高的发病率。我们研究了我们自己进行标准腹会阴联合切除术的结果，以评估是否需要改变策略。
方法
我们对2002年6月至2011年12月在单一中心连续进行的直肠癌标准腹会阴联合切除术进行了回顾性分析。
结果
共有102例患者接受了根治性标准腹会阴联合切除术；19例未接受术前治疗，42例接受了短程放疗，9例接受了长程放疗，32例接受了新辅助化疗，随后接受了长程放化疗。在102例中有17例（16.6%）环周切缘阳性。中位随访32个月，20例患者出现任何类型的复发。5例患者发生局部复发（其中2例也有远处复发），其中2例环周切缘阳性（P = 0.10）。精算的两年仅局部复发率为3.4%，任何复发率为17.7%。总体五年癌症特异性生存率为77%。
结论
在本系列研究中，我们发现即使环周切缘阳性率为16.6%，标准腹会阴联合切除术后局部复发率也较低。在某些病例中进行ELAPE可能会进一步改善这些结果，但并非所有患者都必需。
