Jones Helen J S, Cunningham Chris, Nicholson Gary A, Hompes Roel
Department of Colorectal Surgery, Oxford University Hospitals, United Kingdom.
Department of Colorectal Surgery, Oxford University Hospitals, United Kingdom.
Eur J Surg Oncol. 2018 Jan;44(1):15-23. doi: 10.1016/j.ejso.2017.10.212. Epub 2017 Nov 14.
To establish outcomes after completion and salvage surgery following local excision in literature published since 2005, to inform decision-making when offering local excision.
Local excision of early rectal cancer aims to offer cure while maintaining quality of life through organ preservation. However, some patients will require radical surgery, prompted by unexpected poor pathology or local recurrence. Consistent definition and reporting of these scenarios is poor. We propose the term "salvage surgery" for recurrence after local excision and "completion surgery" for poor pathology.
Electronic databases were searched in February 2016. Studies since 2005 describing outcomes for radical surgery following local excision of rectal cancer were included. Pooled and average values were obtained.
A total of 23 studies included 262 completion and 165 salvage operations. Most completion operations were done within 4 weeks; local recurrence rate was 5% and overall disease recurrence rate was 14%. The majority of salvage operations for local recurrence were within 15 months of local excision, often following adjuvant treatment. Re-do local excision was used in 15%; APR was the most common radical procedure. Further local recurrence was uncommon (3%) but overall disease recurrence rate was 13%. Estimated 5-year survival was in the order of 50%. Heterogeneity was high among the studies.
Patients undergoing local excision must be informed of risks and expected outcomes, but better data on completion and salvage surgery are required to achieve this.
CRD42014014758.
梳理2005年以来发表的文献中局部切除术后完成手术和补救手术的结果，为提供局部切除术时的决策提供参考。
早期直肠癌的局部切除旨在通过保留器官实现治愈并维持生活质量。然而，一些患者会因意外的不良病理或局部复发而需要根治性手术。对这些情况的定义和报告并不统一。我们建议将局部切除术后复发的手术称为“补救手术”，将不良病理情况下的手术称为“完成手术”。
于2016年2月检索电子数据库。纳入2005年以来描述直肠癌局部切除术后根治性手术结果的研究。获取汇总值和平均值。
共有23项研究纳入了262例完成手术和165例补救手术。大多数完成手术在4周内进行；局部复发率为5%，总体疾病复发率为14%。大多数局部复发的补救手术在局部切除后15个月内进行，通常在辅助治疗之后。15%的患者采用再次局部切除；腹会阴联合切除术是最常见的根治性手术。进一步的局部复发并不常见（3%），但总体疾病复发率为13%。估计5年生存率约为50%。各研究之间的异质性较高。
接受局部切除的患者必须了解相关风险和预期结果，但需要更好的关于完成手术和补救手术的数据才能做到这一点。
CRD42014014758。
