James R D, Schofield P F
Br J Surg. 1985 Apr;72(4):279-81. doi: 10.1002/bjs.1800720410.
Forty-two patients with fixed inoperable adenocarcinoma of the rectum due to local extension in the pelvis have been treated using high dose radiotherapy followed by surgery when possible. Inoperability was determined initially by laparotomy in 15 patients and in the remainder by examination under anaesthetic. Twenty-nine patients underwent laparotomy following radiotherapy and resection was performed in 18. In three of these cases there was no residual tumour in the operation specimen. The median survival of the resected group was 28 months compared with 7 months for the unresected group. Treatment related mortality in the resected group was confined to five patients, two postoperative deaths and three small bowel fistulae which developed as late complications. Analysis of prognostic factors indicates that patients most likely to benefit from this approach are those with no evidence of distant metastases or of urinary obstruction at presentation. Patients who have a good clinical response to radiotherapy are more likely to achieve resection and subsequent long-term survival.
42例因盆腔局部浸润而固定无法手术切除的直肠癌患者接受了大剂量放疗，尽可能在放疗后进行手术。15例患者最初通过剖腹手术确定无法手术，其余患者通过麻醉下检查确定。29例患者在放疗后接受了剖腹手术，其中18例进行了切除。在其中3例病例中，手术标本中无残留肿瘤。切除组的中位生存期为28个月，未切除组为7个月。切除组的治疗相关死亡率仅限于5例患者，2例术后死亡，3例发生迟发性并发症的小肠瘘。预后因素分析表明，最有可能从这种方法中获益的患者是那些在就诊时没有远处转移或尿路梗阻证据的患者。对放疗有良好临床反应的患者更有可能实现切除并随后长期存活。
