Nymann T, Jess P, Christiansen J
Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark.
Dis Colon Rectum. 1995 Aug;38(8):799-802. doi: 10.1007/BF02049834.
This study was designed to analyze factors of importance for local recurrence after radical surgery for rectal cancer and to analyze course and outcome of treatment of pelvic recurrence.
One hundred seventy-five patients treated for rectal cancer with low anterior resection (LAR) or abdominoperineal resection (APR) were studied, retrospectively. Seventy-four patients had LAR and 101 had APR.
The two groups were comparable with respect to Dukes classification, histologic differentiation, and male to female ratio. The rate of pelvic recurrence was 18 percent for LAR and 24 percent for APR (not significant). Recurrence rates were 27 percent after stapled anastomoses and 10 percent after handsewn anastomoses respectively (P = 0.09). Twenty five had pelvic recurrence diagnosed without signs of distant metastatic disease. They were treated with radiotherapy, palliative operations, or analgesics. The group receiving radiotherapy had a significantly longer survival (15.9 months) compared with other groups (2.4 months; P < 0.001).
There is no difference in local recurrence rate after LAR and APR. Radiotherapy seems to increase survival in patients with an unresectable recurrence and should be offered irrespective of pain.
本研究旨在分析直肠癌根治术后局部复发的重要因素，并分析盆腔复发的治疗过程及结果。
回顾性研究175例接受低位前切除术（LAR）或腹会阴联合切除术（APR）治疗的直肠癌患者。其中74例行LAR，101例行APR。
两组在 Dukes 分期、组织学分化及男女比例方面具有可比性。LAR组盆腔复发率为18%，APR组为24%（无显著差异）。吻合器吻合术后复发率分别为27%，手工缝合吻合术后复发率为10%（P = 0.09）。25例被诊断为盆腔复发且无远处转移疾病迹象。他们接受了放疗、姑息性手术或镇痛治疗。与其他组（2.4个月；P < 0.001）相比，接受放疗的组生存期显著更长（15.9个月）。
LAR和APR术后局部复发率无差异。放疗似乎可提高不可切除复发患者的生存率，无论有无疼痛均应给予放疗。
