Sugarbaker Paul H, Hassanein Mohamed T
Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, Washington Cancer Institute, Washington, DC, USA.
Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.
Int J Surg Case Rep. 2019;55:233-238. doi: 10.1016/j.ijscr.2019.01.046. Epub 2019 Feb 10.
The resection of a primary colon cancer has the opportunity to cure the patient of cancer by complete clearance and absolute containment of disease. Alternatively, if the cancer resection does not provide clearance and containment it will eventuate in local recurrence and peritoneal dissemination.
Culpability of recurrence of colorectal cancer is difficult to determine. Are the management strategies of the primary cancer evaluation and treatment at fault or is the underlying disease process is to be held responsible? The clinical and radiologic findings that could have been evaluated by a multidisciplinary team (MDT) were critically evaluated in 2 patients with right colon adenocarcinoma. Strategies to accomplish complete clearance and absolute containment of the primary malignancy as resectable for cure were suggested.
Clinical evaluation of these 2 patients suggested that more knowledgeable preoperative evaluation by the multidisciplinary team (MDT) should have placed them in a high risk group for local recurrence and/or peritoneal dissemination. High carcinoembryonic antigen (CEA) tumor marker and by CT a large primary cancer infiltrating adjacent structures can be used to select advanced pre- and intraoperative treatment strategies.
Two patients who had an approximately 50% possibility of long-term survival with optimal preoperative evaluation and expert surgical resection techniques may have been converted to a greatly reduced survival because of tumor dissemination and positive margins of resection at the time of primary cancer resection. Neither patient was evaluated by an MDT preoperatively. It is possible that these two patients entered the operating room with a contained malignancy but as result of suboptimal pre- and intraoperative management left the operating room with disseminated intraperitoneal disease.
原发性结肠癌切除术有机会通过彻底清除和完全控制疾病来治愈患者。否则，如果癌症切除不能实现清除和控制，将会导致局部复发和腹膜播散。
结直肠癌复发的责任难以确定。是原发性癌症评估和治疗的管理策略有误，还是潜在的疾病进程应承担责任？对2例右半结肠癌患者的临床和影像学检查结果进行了严格评估，这些结果本可由多学科团队（MDT）进行评估。提出了实现对可切除的原发性恶性肿瘤进行彻底清除和完全控制的策略，以达到治愈目的。
对这2例患者的临床评估表明，多学科团队（MDT）更专业的术前评估本应将他们归为局部复发和/或腹膜播散的高风险组。高癌胚抗原（CEA）肿瘤标志物以及CT显示的侵犯相邻结构的大的原发性癌症可用于选择先进的术前和术中治疗策略。
两名患者若进行最佳的术前评估和采用专业的手术切除技术，原本有大约50%的长期生存可能性，但由于原发性癌症切除时肿瘤播散和切缘阳性，其生存可能性可能已大幅降低。这两名患者术前均未接受多学科团队（MDT）的评估。有可能这两名患者进入手术室时癌症局限，但由于术前和术中管理欠佳，离开手术室时已出现腹膜内疾病播散。
