Izbicki J R, Hosch S B, Knoefel W T, Passlick B, Bloechle C, Broelsch C E
Department of Surgery, University of Hamburg, Federal Republic of Germany.
Dis Colon Rectum. 1995 Dec;38(12):1251-6. doi: 10.1007/BF02049148.
Locally advanced colorectal cancer often requires extended resection to radically remove all tumor. This is the only chance for cure in these patients, but a higher complication rate would be expected. To evaluate the overall benefit for the patient, this study assesses morbidity and mortality as well as long-term survival of patients who underwent extended resection for a T3-T4 carcinoma.
Two hundred twenty patients with locally advanced adenocarcinoma of the colorectum were included. One hundred fifty presented with a T3 and 70 with a T4 tumor. Eighty-three patients underwent extended resection. In 38 patients extended en bloc resection was performed because of inflammatory adherence mimicking infiltration. Thirty-three patients who underwent extended resections were over 70 years of age. There were no significant differences between the groups that underwent extended or nonextended resections in age, sex, stage, or grading.
pT4 lesions were significantly more frequent in the extended resection group than in the nonextended resection group. Mean survival was 44 months after extended resections and 45 months after nonextended resections. In the extended resection group there was no significant difference in mean survival between pT3 and pT4 stage patients within 46 and 38 months, respectively. In patients who underwent nonextended resections, however, there was a significant difference in mean survival within 48 months for pT3 and 28 for pT4 patients (P < 0.05). Postoperative morbidity and mortality were comparable between the extended resection group and the non-extended resection group. The presence of residual tumor influenced prognosis of patients significantly; R0 resections fared significantly better than patients who underwent R1 or R2 resections (55 and 51 to 14/12 and 23/8 months) (P < 0.01). Nodal stage and International Union Against Cancer stage were also significant determinants of prognosis. After extended resections mean survival morbidity and 30-day mortality in patients more than 70 years was similar to those less than 70 years.
Because extended resections can achieve comparable results in locally more advanced colorectal cancer as nonextended resections in less advanced cancer, an aggressive surgical approach is warranted.
局部进展期结直肠癌通常需要扩大切除范围以彻底清除所有肿瘤。这是这些患者唯一的治愈机会，但预计并发症发生率会更高。为评估对患者的总体益处，本研究评估了接受T3 - T4癌扩大切除患者的发病率、死亡率以及长期生存率。
纳入220例局部进展期结直肠癌患者。150例为T3期肿瘤，70例为T4期肿瘤。83例患者接受了扩大切除。38例患者因类似浸润的炎性粘连而进行了扩大整块切除。33例接受扩大切除的患者年龄超过70岁。接受扩大切除或未扩大切除的组在年龄、性别、分期或分级方面无显著差异。
扩大切除组中pT4病变比未扩大切除组更常见。扩大切除后平均生存期为44个月，未扩大切除后为45个月。在扩大切除组中，pT3和pT4期患者的平均生存期分别在46个月和38个月内无显著差异。然而，在接受未扩大切除的患者中，pT3患者平均生存期为48个月，pT4患者为28个月，存在显著差异（P < 0.05）。扩大切除组和未扩大切除组的术后发病率和死亡率相当。残留肿瘤的存在对患者预后有显著影响；R0切除患者的预后明显优于接受R1或R2切除的患者（分别为55和51个月对14/12和23/8个月）（P < 0.01）。淋巴结分期和国际抗癌联盟分期也是预后的重要决定因素。扩大切除后，70岁以上患者的平均生存发病率和30天死亡率与70岁以下患者相似。
由于在局部更晚期的结直肠癌中，扩大切除可取得与在较早期癌症中未扩大切除相当的结果，因此积极的手术方法是必要的。
