Neville R, Fielding L P, Amendola C
Dis Colon Rectum. 1987 Jan;30(1):12-7. doi: 10.1007/BF02556912.
Local tumor recurrence rates after curative rectal cancer surgery with the end-to-end anastomosis stapler (EEA) are reportedly high. Therefore, a retrospective review in ten Yale-affiliated hospitals was undertaken to establish the outcome of surgical resection for rectal cancer in this patient population. Of those 373 patients who had had curative resections, 192 (52 percent) were abdominoperineal resections (APR); 105 patients (28 percent) had restorative resections with sutured anastomoses, and the EEA stapler was used in 76 patients (20 percent). There was an equal distribution of tumors in the various Dukes' stages in all three procedures. Local tumor recurrence was: APR 19 percent, SUT 17 percent, and EEA 24 percent, but local tumor recurrence was more frequent after EEA than APR for tumors 7 to 10 cm from the anal verge (32 vs. 13 percent, respectively, P less than 0.05), and the time to recurrence was least in EEA patients. It is concluded that local tumor recurrence is higher than expected for all three procedures and that the EEA stapler was associated with a greater risk of local tumor recurrence. These findings are attributed to surgeon-related technical operative factors rather than to the nature of the tumors themselves.
据报道，使用端端吻合器（EEA）进行直肠癌根治性手术后的局部肿瘤复发率很高。因此，在十家耶鲁附属医院进行了一项回顾性研究，以确定该患者群体中直肠癌手术切除的结果。在373例接受根治性切除的患者中，192例（52%）为腹会阴联合切除术（APR）；105例患者（28%）进行了吻合口缝合的根治性切除术，76例患者（20%）使用了EEA吻合器。在所有三种手术中，不同杜克分期的肿瘤分布均匀。局部肿瘤复发率为：APR为19%，缝合吻合术为17%，EEA为24%，但对于距肛缘7至10厘米的肿瘤，EEA术后局部肿瘤复发比APR更频繁（分别为32%和13%，P<0.05），且EEA患者的复发时间最短。结论是，所有三种手术的局部肿瘤复发率均高于预期，且EEA吻合器与局部肿瘤复发风险更高相关。这些发现归因于与外科医生相关的技术操作因素，而非肿瘤本身的性质。
