Cuthbertson A M, Hughes E S, Pihl E
Aust N Z J Surg. 1984 Dec;54(6):549-51.
If colorectal carcinomas where the primary tumours are confined to the wall are considered 'early', the likelihood of lymph node metastasis in these tumours is 21% and for those that do not extend beyond the submucosa it is 13%. Because of the renewed interest in local treatment of small accessible rectal tumours and the use of colonoscopy for the removal of 'polyps' with invasive carcinoma, we analysed our long-term cancer survival figures for 'early' cancers in this combined surgical series spanning more than 30 years. The presence of regional lymph node metastasis in 'early' rectal cancer was associated with a significantly (P = 0.001) reduced proportion of long-term survivors (56%) compared to those without nodal involvement (79%). Long term survival in 'early' colonic cancer was less influenced (P less than 0.05) by whether lymph node metastasis was present (73%) or not (77%). The authors conclude that until more information is available with regard to the risk of lymph node spread from 'early' tumours, resection is advised for all invasive tumours of the colon in good risk patients, but the indications for local excision of 'early' rectal cancers can be extended in view of the ease of careful follow-up and the use of salvage procedures in those with recurrence.
如果将原发肿瘤局限于肠壁的结直肠癌视为“早期”，那么这些肿瘤发生淋巴结转移的可能性为21%，而对于那些未超出黏膜下层的肿瘤，这一比例为13%。由于人们对易于触及的小直肠肿瘤的局部治疗重新产生兴趣，且使用结肠镜检查来切除伴有浸润性癌的“息肉”，我们分析了在这个跨度超过30年的联合手术系列中“早期”癌症的长期癌症生存数据。与无淋巴结受累的患者（79%）相比，“早期”直肠癌出现区域淋巴结转移的患者长期存活者比例显著降低（56%，P = 0.001）。“早期”结肠癌的长期生存受是否存在淋巴结转移的影响较小（P < 0.05），存在淋巴结转移的患者长期生存率为73%，无淋巴结转移的患者为77%。作者得出结论，在获得更多关于“早期”肿瘤淋巴结转移风险的信息之前，建议对所有风险状况良好的结肠癌浸润性肿瘤患者进行切除，但鉴于易于进行仔细随访以及对复发患者采用挽救性手术，“早期”直肠癌局部切除的指征可以放宽。
