McDermott F, Hughes E, Pihl E, Milne B J, Price A
Surg Gynecol Obstet. 1982 Jun;154(6):833-7.
Restorative resection for carcinoma of the middle third of the rectum has been facilitated by the recent introduction of the staplers. Before restorative resection with end-to-end anastomosis can become the treatment of choice, it must be proved that survival prospects after restorative resection are similar to those obtained after total abdominoperineal excision. The results of curative restorative resection and total excision in 417 patients with a single carcinoma of the middle third of the rectum managed by one of us are examined. Between 1950 and 1980, the proportion of patients treated by restorative resection for carcinoma of the middle third of the rectum increased from 26 to 93 per cent. Distribution by sex, age, tumor stage and tumor differentiation did not differ significantly between the two groups of patients operated upon. Cancer specific survival did not differ significantly between patients treated by restorative resection or total excision. Ten year survival rates were 60 and 59 per cent, respectively. Survival related to tumor stage and differentiation was not influenced by the type of operation. Tumor size, greater--p less than 0.04--in patients managed by total excision, had no significant influence on survival prospects. The results justify sphincter preservation and suggest that increased usage of restorative resection by stapling technique is not likely to lessen survival prospects in patients with carcinoma of the middle third of the rectum.
吻合器的近期问世促进了直肠中1/3癌的根治性切除。在端端吻合的根治性切除成为首选治疗方法之前，必须证明根治性切除后的生存前景与经腹会阴联合全切除后的生存前景相似。我们对417例直肠中1/3单发癌患者采用根治性切除和全切除的结果进行了研究。1950年至1980年间，直肠中1/3癌采用根治性切除治疗的患者比例从26%增至93%。两组手术患者的性别、年龄、肿瘤分期和肿瘤分化分布无显著差异。根治性切除或全切除治疗的患者癌症特异性生存率无显著差异。10年生存率分别为60%和59%。与肿瘤分期和分化相关的生存情况不受手术类型的影响。在接受全切除治疗的患者中，肿瘤大小（p＜0.04）对生存前景无显著影响。这些结果证明保留括约肌是合理的，并表明通过吻合技术增加根治性切除的应用不太可能降低直肠中1/3癌患者的生存前景。
