Díaz-Plasencia J, Tantaleán E, Urtecho F, Guzmán C, Angulo M, Carranza C, Tuesta E
Departamento de Cirugía, Hospital Belén.
Rev Gastroenterol Peru. 1996 Jan-Apr;16(1):48-56.
Retrospectively collected information on 77 patients who had undergone resection for colorectal cancer at Belén Hospital, Trujillo, Perú, from 1966 to 1993, was analyzed to establish their clinical features and the importance of both clinical and pathological factors affecting outcome. Common presenting features in right colon cancer were abdominal pain, pallor, and palpable mass; in left colon cancer were symptoms of obstruction, and in rectal carcinoma predominated bleeding. The diagnostic accuracy of barium enema (n = 25) and proctosigmoidoscopy (n = 18) was 72 and 100% respectively. In 54.5% (n = 42) curative resection and in 45.5% (n = 35) palliative resection was performed The surgical procedures performed were right hemicolectomy (n = 29), transverse colectomy (n = 6), left hemicolectomy (n = 11), sigmoid resection (n = 14), low anterior resection (n = 5), and abdominoperineal resection of the rectum (n = 12). The total perioperative mortality rate was 18%. The 5 year survival rate in this series was 28% (53% for curative resection and 0% for palliative resection). An univariate analysis of survival time using long-rank test revealed that presence of bowel obstruction or perforation, macroscopic appearance, tumor size, depth of invasion, lymph node status, number of lymph node metastasis, distant metastasis, and clinical stage had and individual prognostic significance. Age, sex, length of disease, serum hemoglobin level, blood transfusions, location of tumor, histologic type, and tumor grade did not affect the prognosis. Improvement in the survival probably depends on development of better adjuvant therapy in association with surgery.
回顾性收集了1966年至1993年在秘鲁特鲁希略贝伦医院接受结直肠癌切除术的77例患者的信息,分析其临床特征以及影响预后的临床和病理因素的重要性。右结肠癌的常见表现为腹痛、面色苍白和可触及肿块;左结肠癌为梗阻症状,直肠癌则以出血为主。钡灌肠(n = 25)和直肠乙状结肠镜检查(n = 18)的诊断准确率分别为72%和100%。42例(54.5%)患者进行了根治性切除,35例(45.5%)患者进行了姑息性切除。所实施的手术包括右半结肠切除术(n = 29)、横结肠切除术(n = 6)、左半结肠切除术(n = 11)、乙状结肠切除术(n = 14)、低位前切除术(n = 5)以及腹会阴联合直肠癌切除术(n = 12)。围手术期总死亡率为18%。该系列患者的5年生存率为28%(根治性切除患者为53%,姑息性切除患者为0%)。使用长秩检验对生存时间进行单因素分析显示,肠梗阻或穿孔的存在、大体外观、肿瘤大小、浸润深度、淋巴结状态、淋巴结转移数量、远处转移以及临床分期均具有个体预后意义。年龄、性别、病程长短、血清血红蛋白水平、输血情况、肿瘤位置、组织学类型以及肿瘤分级均不影响预后。生存率的提高可能取决于与手术相关的更好辅助治疗的发展。