Moriya Y, Sugihara K, Akasu T, Fujita S
Department of Surgery, National Cancer Hospital, Tokyo, Japan.
Dis Colon Rectum. 1995 Nov;38(11):1162-8. doi: 10.1007/BF02048331.
Since the early 1980s to relieve functional disturbances after rectal excision, we have been performing nerve-sparing surgery for rectal cancer. The aim of this study was to analyze patterns of recurrences, especially concerning causes of local ones. Furthermore, we would like to address the criteria we used in patient selection to effect successful nerve-sparing surgery.
From 1982 to 1991, 306 patients underwent nerve-sparing operations, which may be categorized into three types: 1) total autonomic nerve preservation (125 cases), 2) complete pelvic nerve preservation (105 cases), and 3) partial pelvic nerve preservation with removal of parasympathetic nerve (79 cases). Single and multivariant regression analyses were conducted to investigate patterns of recurrence, especially causes of local ones.
Sixty-five patients (21 percent) developed recurrent tumors, 19 of which (6.2 percent) were local. Using Dukes terms, there were five patients with Dukes A 13 with Dukes B, and 47 (35 percent) with Dukes C stages. Rate of local recurrences was 13 percent in patients with Dukes C tumor. According to single-variant analysis of Dukes C patients, the following factors are thought to influence local recurrences: number of lymph nodes metastases, level of primary growth, and direction of lymphatic spread. Multivariate regression analysis suggested that lymph node metastasis was the most important and influencing factor on local regrowth (P < 0.002).
Compared with local recurrences is so-called extended surgery appeared to be lower. Our current policy is aggressive application of nerve-sparing surgery, even to patients with node-positive rectal cancer, taking into consideration the exact extent of cancer spread. From the viewpoint of neuroanatomy related to mesorectum, we discussed patient determination for our nerve-sparing surgery.
自20世纪80年代初以来，为缓解直肠切除术后的功能障碍，我们一直开展直肠癌保留神经手术。本研究旨在分析复发模式，尤其是局部复发的原因。此外，我们还想阐述在患者选择中用于实现成功保留神经手术的标准。
1982年至1991年，306例患者接受了保留神经手术，可分为三种类型：1）完全自主神经保留（125例），2）完全盆腔神经保留（105例），3）部分盆腔神经保留并切除副交感神经（79例）。进行单变量和多变量回归分析以研究复发模式，尤其是局部复发的原因。
65例患者（21%）出现肿瘤复发，其中19例（6.2%）为局部复发。按照杜克斯分期，有5例杜克斯A期、13例杜克斯B期和47例（35%）杜克斯C期患者。杜克斯C期肿瘤患者的局部复发率为13%。根据对杜克斯C期患者的单变量分析，以下因素被认为会影响局部复发：淋巴结转移数量、原发肿瘤生长水平和淋巴扩散方向。多变量回归分析表明，淋巴结转移是局部复发最重要的影响因素（P < 0.002）。
与局部复发相比，所谓的扩大手术似乎较低。我们目前的策略是积极应用保留神经手术，即使是对淋巴结阳性的直肠癌患者，同时考虑癌症扩散的确切范围。从与直肠系膜相关的神经解剖学角度，我们讨论了保留神经手术的患者选择。
