Luna-Pérez P, Fernández A, Labastida S, Acevedo C, Torres S, Padilla R, Herrera Ornelas L
Departamento de Cirugía Oncológica, Tumores Mixtos, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS.
Gac Med Mex. 1994 Sep-Oct;130(5):380-5.
In order to define the role of radical surgery in the actual treatment of epidermoid carcinoma of the anal canal (ECAC), we retrospectively reviewed the charts of patients with primary ECAC, treated with radical surgery in the Hospital de Oncología, National Medical Center IMSS. We analyzed the recurrence pattern, its treatment and the contemporary literature was reviewed. From 1975 to 1990, we treated 16 patients; 13 females, 3 males, mean age was 64 years. The presurgical stage was T2, 6; T3 7; T4, 3. An abdominoperineal resection was performed in 12 patients; a posterior pelvic exenteration in 3; a total pelvic exenteration in 1. Ten patients developed surgical complications, 4 of them were major, 2 required surgical reintervention. There was no operative mortality. We obtained local tumor control in 5/16 patients (32%); the local recurrence by stage were T2, 3/6 (50%); T3, 5/7 (71%); T4, 3/3 (100%) p = 0.04. Ten of them were located at the pelvis brim and 1 was located to the central pelvis (vagina, perineum), 9 were treated with radiation therapy (RT) a mean dose of 45 Gy, only the patient with central local recurrence obtained local tumor control. Regional recurrences were as follows: T2 patients, 1/6 (16%); T3, 2/7 (28%); T4, 2/3 (66%). The 2 patients with metachronous inguinal lymph node metastases were treated with a radical groin dissection, with tumor control. In conclusion, the radical surgical treatment is associated with a low loco-regional tumor control; the pelvic tumor relapses were located at the pelvis brim and with no response to RT. With the results herein obtained and the results with other treatment modalities such as RT and its associations with chemotherapy (C) in regard to local tumor control, the actual role of the radical surgical treatment in the salvage of central pelvic relapses to primary treatment with RT or C-RT.
为了明确根治性手术在肛管表皮样癌（ECAC）实际治疗中的作用，我们回顾性分析了在国家医学中心IMSS肿瘤医院接受根治性手术治疗的原发性ECAC患者的病历。我们分析了复发模式、其治疗方法，并查阅了当代文献。1975年至1990年，我们共治疗了16例患者；其中女性13例，男性3例，平均年龄64岁。术前分期为T2期6例；T3期7例；T4期3例。12例行腹会阴联合切除术；3例行后盆腔脏器清除术；1例行全盆腔脏器清除术。10例患者出现手术并发症，其中4例为严重并发症，2例需要再次手术干预。无手术死亡病例。16例患者中有5例（32%）实现了局部肿瘤控制；按分期局部复发情况为：T2期，6例中的3例（50%）；T3期，7例中的5例（71%）；T4期，3例中的3例（100%），p = 0.04。其中10例位于骨盆边缘，1例位于中盆腔（阴道、会阴），9例接受了平均剂量为45 Gy的放射治疗（RT），只有中盆腔局部复发的患者实现了局部肿瘤控制。区域复发情况如下：T2期患者，6例中的1例（16%）；T3期，7例中的2例（28%）；T4期，3例中的2例（66%）。2例出现异时性腹股沟淋巴结转移的患者接受了根治性腹股沟淋巴结清扫术，实现了肿瘤控制。总之，根治性手术治疗的局部区域肿瘤控制率较低；盆腔肿瘤复发位于骨盆边缘，对放射治疗无反应。根据本文获得的结果以及其他治疗方式（如放射治疗及其与化疗（C）联合）在局部肿瘤控制方面的结果，根治性手术治疗在挽救中盆腔复发至放射治疗或放化疗（C-RT）初始治疗中的实际作用。
