Sugarbaker P H, Corlew S
Dis Colon Rectum. 1982 Sep;25(6):545-57. doi: 10.1007/BF02564164.
This review was undertaken in an attempt to accumulate and critically evaluate all evidence that suggests that special techniques may alter survival rates of patients undergoing surgery for large-bowel cancer. Data suggesting reduced survival with a distal margin of resection less than 5 cm in patients undergoing anterior resection were found to be inconsistent. En bloc removal of the primary tumor and an adhesed adjacent structure seemed important, for 30 to 60 per cent survival has been reported using this approach, and adhesions were found to contain malignant cells at the interface of the primary tumor and adjacent structure in 40 to 100 per cent of patients. No statistically significant differences in survival rates were found in studies comparing conservative segmental bowel resection with radical hemicolectomy. This was true for colonic as well as rectal resections; while patient morbidity was not markedly increased for radical colectomy, it was found to be much greater with radical rectal resections. No data to support the use of "no-touch techniques" could be uncovered. Data to support the use of techniques for control of intraluminal tumor cells were sparse; however, because these maneuvers cost the patient little in terms of added morbidity, they should be used. Important aspects of the techniques for large-bowel surgery need to be investigated by prospective controlled clinical trials.
本综述旨在积累并批判性评估所有表明特殊技术可能改变接受大肠癌手术患者生存率的证据。发现在接受前切除术的患者中，切除远端切缘小于5 cm会降低生存率的数据并不一致。整块切除原发性肿瘤和粘连的相邻结构似乎很重要，因为据报道采用这种方法的生存率为30%至60%，并且在40%至100%的患者中发现粘连在原发性肿瘤与相邻结构的界面处含有恶性细胞。在比较保守节段性肠切除术与根治性半结肠切除术的研究中，未发现生存率有统计学上的显著差异。结肠和直肠切除术都是如此；虽然根治性结肠切除术患者的发病率没有明显增加，但发现根治性直肠切除术的发病率要高得多。未发现支持使用“不接触技术”的数据。支持使用控制腔内肿瘤细胞技术的数据很少；然而，由于这些操作给患者增加的发病率很小，因此应该使用。大肠手术技术的重要方面需要通过前瞻性对照临床试验进行研究。
