Yeung R S, Moffat F L, Falk R E
Department of Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
Cancer. 1993 Sep 15;72(6):1853-8. doi: 10.1002/1097-0142(19930915)72:6<1853::aid-cncr2820720611>3.0.co;2-v.
Local failure after curative surgery for colorectal adenocarcinoma remains a major source of morbidity and mortality. This retrospective analysis reviews the authors' experience with pelvic exenteration in the setting of recurrent and locally advanced colorectal cancer.
Between 1979 and 1986, 50 pelvic exenterations were performed for recurrent (43) and primary (7) colorectal pelvic malignancies. Of these, 30 patients were operated on with curative intent, whereas 20 underwent operation for palliation of intractable pain, sepsis, fistula, bleeding, or bowel obstruction. Twenty-six patients had received radiation to 4000 cGy or more. Of the recurrent tumors, the median time from primary treatment to exenteration was 39.7 months.
Postoperative mortality included 7 in-hospital deaths (14%): 5 of 20 in the palliative group and 2 of 30 in the curative group. Complications were common (a total of 71 occurrences), but there has been a significant decrease with experience. The median survival was 19 months for the curative group and 10 months for the palliative group, excluding perioperative mortality. The 5-year survival was 6% overall, and 10% for the curative group. Eighty-nine percent of patients in the curative group had significant pain relief (71% complete, 18% partial), whereas 67% of those in the palliative group had complete or partial pain control.
Long-term survival after pelvic exenteration for recurrent colorectal carcinoma is uncommon (2/43), but sustained palliation and local control can be achieved with acceptable morbidity and mortality in most patients with intractable pelvic symptoms.
结直肠癌根治性手术后的局部复发仍然是发病和死亡的主要原因。本回顾性分析总结了作者在复发性和局部晚期结直肠癌患者中行盆腔脏器清扫术的经验。
1979年至1986年间，对43例复发性和7例原发性结直肠癌盆腔恶性肿瘤患者实施了50例盆腔脏器清扫术。其中，30例患者接受手术的目的是根治，而20例患者接受手术是为了缓解顽固性疼痛、败血症、瘘管、出血或肠梗阻。26例患者接受了4000 cGy或更高剂量的放疗。复发性肿瘤患者从初次治疗到行盆腔脏器清扫术的中位时间为39.7个月。
术后死亡率包括7例住院死亡（14%）：姑息治疗组20例中有5例，根治性治疗组30例中有2例。并发症很常见（共发生71次），但随着经验的积累，并发症发生率显著下降。排除围手术期死亡率后，根治性治疗组的中位生存期为19个月，姑息治疗组为10个月。总体5年生存率为6%，根治性治疗组为10%。根治性治疗组89%的患者疼痛得到显著缓解（完全缓解71%，部分缓解18%），而姑息治疗组67%的患者疼痛得到完全或部分控制。
复发性结直肠癌患者行盆腔脏器清扫术后长期生存并不常见（43例中有2例），但大多数有顽固性盆腔症状的患者可实现持续的姑息治疗和局部控制，且发病率和死亡率可接受。
