de Graaf P W, Roussel J G, Gortzak E, Hart G A, Jongman A, van Slooten E A
J Surg Oncol. 1985 Jun;29(2):123-8. doi: 10.1002/jso.2930290211.
For some small rectal cancers electrofulguration can be an attractive alternative to more extensive surgical procedures. This report is a review of 49 patients who, after careful selection, were considered ideal candidates for curative fulguration in the period 1959-1982. All had rectal adenocarcinomas and were clinically staged as Dukes' A tumors. To put the results of this analysis into perspective, they are compared to the results of those patients (34) who also had early clinical stage rectal adenocarcinomas, but for a variety of reasons underwent abdominoperineal excisions (APE, 11 patients) or low-anterior resections (LAR, 23 patients) instead of fulguration. Postoperative complications after fulguration were minimal, there were no postoperative deaths, and all patients retained anal continence. After APE or LAR there were two postoperative deaths (one myocardial infarction, one ruptured iliac aneurysm); postoperative morbidity was greater. All LAR-treated patients remained continent. Of the patients at risk 55% remained disease-free after fulguration, while 77% remained disease-free after APE or LAR (P = 0.023). This is due to a higher percentage of loco-regional recurrences occurring after fulguration than after APE or LAR (31% vs 9%, respectively, P = 0.021). The percentage of patients with distant metastases in both groups are similar. It seems that electrofulguration of rectal cancers, even in strictly selected patients in a specialized institution, can lead to an unacceptably high percentage of patients with loco-regional recurrences. Nearly all local failures occurred in patients with tumors that measured more than 3 cm in diameter and/or occupied more than one-third of the rectal circumference. Salvage operations for loco-regional failure were performed in 13 patients, 5 of whom are alive with no evidence of disease. Since there seems to be a direct relation between tumor size and the chance of loco-regional recurrence and since salvage operations for local failure are not uniformly successful, electrofulguration for cure must be reserved for the very rare patient with a very small early-stage rectal cancer.
对于一些小的直肠癌，电灼术可以成为比更广泛手术程序更具吸引力的替代方法。本报告回顾了1959年至1982年期间经过仔细挑选被认为是根治性电灼术理想候选者的49例患者。所有患者均患有直肠腺癌，临床分期为Dukes A期肿瘤。为了客观看待该分析结果，将其与那些同样患有早期临床分期直肠腺癌，但因各种原因接受腹会阴联合切除术（APE，11例患者）或低位前切除术（LAR，23例患者）而非电灼术的患者（34例）的结果进行了比较。电灼术后的术后并发症极少，无术后死亡病例，且所有患者均保持了肛门节制功能。APE或LAR术后有2例术后死亡（1例心肌梗死，1例髂动脉瘤破裂）；术后发病率更高。所有接受LAR治疗的患者均保持了节制功能。在有风险的患者中，电灼术后55%无疾病复发，而APE或LAR术后77%无疾病复发（P = 0.023）。这是因为电灼术后局部区域复发的百分比高于APE或LAR术后（分别为31%和9%，P = 0.021）。两组远处转移患者的百分比相似。似乎直肠癌的电灼术，即使是在专业机构中经过严格挑选的患者，也会导致局部区域复发的患者比例高得令人难以接受。几乎所有局部失败都发生在肿瘤直径超过3 cm和/或占据直肠周长超过三分之一的患者中。对13例局部区域失败的患者进行了挽救性手术，其中5例存活且无疾病证据。由于肿瘤大小与局部区域复发几率之间似乎存在直接关系，且局部失败的挽救性手术并非都能成功，因此根治性电灼术必须仅用于极少数患有非常小的早期直肠癌的患者。
