Ledesma E J, Tseng M, Mittelman A
Cancer. 1982 Nov 1;50(9):1884-7. doi: 10.1002/1097-0142(19821101)50:9<1884::aid-cncr2820500939>3.0.co;2-6.
Isolated abdominal wall recurrence, following resection of a primary large bowel adenocarcinoma, is an infrequent finding. Over a ten year period, 22 patients were submitted to en bloc resection of such localized neoplastic foci. In 13 cases, recurrent tumor was located in a previous midline or para median incision. Nine patients underwent palliative radiotherapy and/or chemotherapy once the recurrent disease was identified, and were operated on when uncontrolled progression was clinically evident. In all cases, 4-5 cm disease-free margins were obtained. In eight patients it was possible to close the defect primarily and 14 patients required marlex mesh. Twelve patients were alive at two years and ten patients at five-years follow-up mark. Mucin-producing or poorly differentiated adenocarcinoma had the worse prognosis. Synthetic prosthesis allowed for adequate resections with little morbidity and acceptable cosmesis. Symptomatic relief and long-term palliation can be achieved with aggressive surgery. The role of adjuvant chemotherapy and radiation therapy still needs to be evaluated. The aggressiveness of poorly differentiated and the mucin producing adenocarcinoma should temper radical surgical exercises.
原发性大肠腺癌切除术后孤立性腹壁复发是一种罕见的情况。在十年期间，22例患者接受了此类局限性肿瘤病灶的整块切除。13例中，复发性肿瘤位于先前的中线或旁正中切口处。9例患者在复发性疾病确诊后接受了姑息性放疗和/或化疗，在临床明显出现病情无法控制的进展时接受了手术。所有病例均获得了4 - 5厘米的切缘阴性。8例患者能够一期缝合缺损，14例患者需要使用Marlex网片。12例患者在两年随访时存活，10例患者在五年随访时存活。产生黏液的腺癌或低分化腺癌预后较差。合成假体可实现充分切除，并发症少且美容效果可接受。积极的手术可实现症状缓解和长期姑息治疗。辅助化疗和放疗的作用仍需评估。低分化和产生黏液的腺癌的侵袭性应限制根治性手术操作。
