Fielding L P, Stewart-Brown S, Blesovsky L
Br Med J. 1979 Sep 1;2(6189):515-7. doi: 10.1136/bmj.2.6189.515.
Patients with obstructing large-bowel cancer may be treated by primary tumour resection or the conventional staged tumour resection, and a prospective study comparing these two treatments was carried out. The post-operative outcome in 174 patients (of whom 90 underwent primary and 47 staged tumour resection) showed that the overall mortality was similar in both groups but that the duration of hospital stay in patients who underwent primary tumour resection was half that of those who underwent staged tumour resection. The mortality for primary tumour resection, however, was unexpectedly high for lesions proximal to the splenic flexure and unexpectedly low for lesions distal to this point. Of patients with distal tumours in whom a staged resection was planned, 35% died after a loop colostomy. The most striking result was that the ratio of postoperative death for trainee surgeons compared with fully trained surgeons was 3:1. It is concluded that patients with large-bowel cancer who present with intestinal obstruction should be treated by a fully trained surgeon and that immediate resection of the tumour should be considered for every patient.
患有梗阻性大肠癌的患者可采用原发性肿瘤切除术或传统的分期肿瘤切除术进行治疗，为此开展了一项比较这两种治疗方法的前瞻性研究。174例患者（其中90例行原发性肿瘤切除术，47例行分期肿瘤切除术）的术后结果显示，两组的总体死亡率相似，但接受原发性肿瘤切除术的患者住院时间是接受分期肿瘤切除术患者的一半。然而，脾曲近端病变的原发性肿瘤切除术死亡率意外地高，而该点远端病变的死亡率意外地低。在计划进行分期切除术的远端肿瘤患者中，35%在进行袢式结肠造口术后死亡。最显著的结果是，实习外科医生与训练有素的外科医生的术后死亡率之比为3:1。得出的结论是，患有肠梗阻的大肠癌患者应由训练有素的外科医生进行治疗，并且应考虑对每位患者立即进行肿瘤切除术。
