孤立性结直肠癌区域性复发的治愈性手术:文献复习与机构经验。
Curative-intent surgery for isolated locoregional recurrence of colon cancer: Review of the literature and institutional experience.
机构信息
Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands.
出版信息
Eur J Surg Oncol. 2020 Sep;46(9):1673-1682. doi: 10.1016/j.ejso.2020.04.021. Epub 2020 Apr 28.
BACKGROUND
Locoregional recurrence of colon cancer (LRCC) following curative resection is an underreported clinical entity, especially regarding isolated LRCC which is amenable for surgery. The purpose of this study was to review the literature on incidence of LRCC and surgical treatment with corresponding outcome, and to describe an institutional experience with curative-intent surgery, whether or not as part of a multimodality approach.
METHODS
The PubMed and Medline literature databases 1978-2017 were searched and retrieved articles were assessed for eligibility. Based on a prospectively maintained database since 2010 at a tertiary referral center, original patient files were retrospectively reviewed.
RESULTS
Systematic literature review resulted in 11 studies reporting on incidence of LRCC, which ranged from 3.1% to 19.0% before 2010, and from 4.4% to 6.7% in three most recent studies. Twelve identified studies reported on outcome of surgically treated LRCC, with a median survival of 30 and 33 months in the two largest studies. The institutional database entailed 17 patients who underwent resection of isolated LRCC between 2010 and 2018. Median time to recurrence was 19 months. After a median follow-up after resection of LRCC of 20 months, 7 patients had died, 9 patients were alive without evidence of disease and 1 patient with evidence of disease; Median DFS was 36 months and 3-year OS was 65%.
CONCLUSION
Locoregional recurrence of colon cancer occurs in about 5% in most recent series, of whom selected patients are eligible for surgical treatment, with a fair chance of long-term disease control.
背景
结肠癌(CRC)根治性切除术后局部区域复发(LRCC)是一种报道较少的临床实体,尤其是孤立性 LRCC 可手术治疗。本研究的目的是复习有关 LRCC 发生率和手术治疗及相应结果的文献,并描述本机构采用根治性手术治疗孤立性 LRCC 的经验,无论是否作为多模式治疗的一部分。
方法
检索 1978 年至 2017 年期间的 PubMed 和 Medline 文献数据库,并对符合条件的文章进行评估。根据 2010 年以来在一家三级转诊中心建立的前瞻性数据库,回顾性分析原始患者病历。
结果
系统文献复习结果显示,11 项研究报告了 LRCC 的发生率,2010 年前的发生率为 3.1%至 19.0%,最近 3 项研究的发生率为 4.4%至 6.7%。12 项已确定的研究报告了手术治疗 LRCC 的结果,两项最大的研究中,中位生存期分别为 30 个月和 33 个月。本机构数据库纳入了 2010 年至 2018 年间接受孤立性 LRCC 切除术的 17 例患者。复发中位时间为 19 个月。LRCC 切除后中位随访 20 个月时,7 例患者死亡,9 例患者无疾病证据且存活,1 例患者有疾病证据;中位无病生存率为 36 个月,3 年总生存率为 65%。
结论
最近的系列研究中,约 5%的患者发生局部区域复发,其中部分患者适合手术治疗,长期疾病控制的机会较大。