Hida J, Yasutomi M, Shindoh K, Kitaoka M, Fujimoto K, Ieda S, Machidera N, Kubo R, Morikawa E, Inufusa H, Watatani M, Okuno K
First Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
Dis Colon Rectum. 1996 Jan;39(1):74-9. doi: 10.1007/BF02048273.
The usefulness of postoperative carcinoembryonic antigen (CEA) monitoring and improvements in imaging techniques have renewed enthusiasm for second-look operations (SLO) as the most effective treatment for recurrent colorectal cancer by reresection following early detection. The aim of our study is to evaluate the role of CEA and imaging techniques-directed SLO.
Seven hundred fifty-six patients with Dukes Stages B and C, who had undergone curative resection, were monitored postoperatively using CEA and imaging techniques. An SLO was performed on any potentially resectable recurrence, and in addition, an SLO was done when a persistently rising CEA value was detected.
Recurrence developed in 18.8 percent (142/756) of patients, and 90.8 percent (129/142) of the recurrences were detected within the first three years following curative resection. When comparing carcinomas of the colon with that of the rectum, the former were associated with significantly more hepatic and intraabdominal recurrences, whereas the latter had significantly more locoregional and pulmonary recurrences. Seventy-two patients underwent SLO. Of these patients, 54.2 percent (39/72) had all of their disease resected, and 1.4 percent (1/72) had no detectable disease at the SLO. Among the 142 patients with recurrence, 71 (50 percent) patients underwent SLO. The resectable group at SLO carried a significantly better survival than the unresectable recurrence group (41.3 vs. 5.2 percent; P<0.01).
Complete removal of colorectal cancer recurrences by SLO, on the basis of postoperative, follow-up CEA and imaging technique findings, results in improved survival.
术后癌胚抗原（CEA）监测的实用性以及成像技术的改进，重新激发了人们对二次探查手术（SLO）的热情，认为其是通过早期检测后再次切除来治疗复发性结直肠癌的最有效方法。我们研究的目的是评估CEA和成像技术引导下的二次探查手术的作用。
756例接受根治性切除的Dukes B期和C期患者术后采用CEA和成像技术进行监测。对任何可能可切除的复发灶进行二次探查手术，此外，当检测到CEA值持续升高时也进行二次探查手术。
18.8%（142/756）的患者出现复发，90.8%（129/142）的复发在根治性切除后的前三年内被检测到。比较结肠癌和直肠癌时，前者肝转移和腹内复发明显更多，而后者局部区域和肺转移明显更多。72例患者接受了二次探查手术。在这些患者中，54.2%（39/72）的患者所有病灶均被切除，1.4%（1/72）的患者在二次探查手术时未检测到病灶。在142例复发患者中，71例（50%）接受了二次探查手术。二次探查手术时可切除组的生存率明显高于不可切除的复发组（41.3%对5.2%；P<0.01）。
根据术后CEA和成像技术检查结果，通过二次探查手术完全切除结直肠癌复发灶可提高生存率。
