Department of Molecular Medicine and Surgery, Karolinska Institutet and Division of Surgery, Danderyd Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet and Center of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Br J Surg. 2019 May;106(6):790-798. doi: 10.1002/bjs.11098. Epub 2019 Feb 18.
Population-based studies of treatment of locally recurrent rectal cancer (LRRC) are lacking. The aim was to investigate the surgical treatment of patients with LRRC at a national population-based level.
All patients undergoing abdominal resection for primary rectal cancer between 1995 and 2002 in Sweden with LRRC as a first event were included. Detailed information about treatment, complications and outcomes was collected from the medical records. The patients were analysed in three groups: patients who had resection of the LRRC, those treated without tumour resection and patients who received best supportive care only.
In all, 426 patients were included in the study. Of these, 149 (35·0 per cent) underwent tumour resection, 193 (45·3 per cent) had treatment without tumour resection and 84 (19·7 per cent) received best supportive care. Abdominoperineal resection was the most frequent surgical procedure, performed in 65 patients (43·6 per cent of those who had tumour resection). Thirteen patients had total pelvic exenteration. In total, 63·8 per cent of those whose tumour was resected had potentially curative surgery. After tumour resection, 62 patients (41·6 per cent) had a complication within 30 days. Patients who received surgical treatment without tumour resection had a lower complication rate but a significantly higher 30-day mortality rate than those who underwent tumour resection (10 versus 1·3 per cent respectively; P = 0·002). Of all patients included in the study, 22·3 per cent had potentially curative treatment and the 3-year survival rate for these patients was 56 per cent.
LRRC is a serious condition with overall poor outcome. Patients undergoing curative surgery have an acceptable survival rate but substantial morbidity. There is room for improvement in the management of patients with LRRC.
缺乏基于人群的局部复发性直肠癌（LRRC）治疗研究。本研究旨在从全国人群的角度研究 LRRC 患者的手术治疗方法。
纳入了 1995 年至 2002 年期间在瑞典接受原发性直肠癌腹部切除术且首次发生 LRRC 的所有患者。从病历中收集了关于治疗、并发症和结局的详细信息。将患者分为三组：LRRC 切除组、未切除肿瘤组和仅接受最佳支持治疗组。
共有 426 例患者纳入研究。其中，149 例（35.0%）接受了肿瘤切除术，193 例（45.3%）未切除肿瘤治疗，84 例（19.7%）接受了最佳支持治疗。腹会阴联合切除术是最常见的手术方式，65 例患者（肿瘤切除组的 43.6%）接受了该手术。13 例患者接受了全盆腔切除术。总体而言，63.8%的肿瘤切除患者接受了潜在治愈性手术。肿瘤切除后，62 例（41.6%）患者在 30 天内出现并发症。未切除肿瘤的手术治疗患者的并发症发生率较低，但 30 天死亡率明显高于肿瘤切除患者（分别为 10%和 1.3%；P=0.002）。在所有纳入研究的患者中，22.3%的患者接受了潜在的治愈性治疗，这些患者的 3 年生存率为 56%。
LRRC 是一种严重的疾病，总体预后较差。接受根治性手术的患者有可接受的生存率，但发病率较高。LRRC 患者的管理仍有改进的空间。
