Arbman G, Nilsson E, Hallböök O, Sjödahl R
Department of Surgery, Central Hospital, Norrköping, Sweden.
Br J Surg. 1996 Mar;83(3):375-9. doi: 10.1002/bjs.1800830326.
Early results after rectal cancer surgery in a defined population were compared before and after the introduction of total mesorectal excision. In the first period (1984-1986) 211 cases of rectal cancer were diagnosed and in the second (1990-1992) 230. Of these, 134 patients in the first period (group 1) had anterior resection or abdominoperineal excision which was considered curative. In the second period 128 curative anterior resections and abdominoperineal excisions were performed by a limited number of surgeons familiar with total mesorectal excision (group 2). No differences between the groups were found in stage distribution, rate of curative operations, postoperative complications or postoperative mortality. Local recurrence had developed in 19 patients in group 1 and in eight in group 2, 1 year after the end of the study periods (P = 0.03). Local radicality was in doubt in 13 patients in group 1 and in eight in group 2. In the remaining 121 and 120 patients, 13 and four local recurrences respectively were present (P = 0.03). Actuarial analysis showed a significant reduction in local recurrence rate (P = 0.03) and an increase in crude survival (P = 0.03) at 4 years in group 2 compared with group 1. Total mesorectal excision reduces the local recurrence rate after excision of rectal cancer.
在引入全直肠系膜切除术前后，对特定人群直肠癌手术后的早期结果进行了比较。在第一阶段（1984 - 1986年）诊断出211例直肠癌，第二阶段（1990 - 1992年）诊断出230例。其中，第一阶段的134例患者（第1组）接受了被认为是根治性的前切除术或腹会阴联合切除术。在第二阶段，由少数熟悉全直肠系膜切除术的外科医生进行了128例根治性前切除术和腹会阴联合切除术（第2组）。两组在分期分布、根治性手术率、术后并发症或术后死亡率方面均未发现差异。在研究期结束1年后，第1组有19例患者发生局部复发，第2组有8例（P = 0.03）。第1组有13例患者、第2组有8例患者的局部根治性存疑。在其余的121例和120例患者中，分别有13例和4例出现局部复发（P = 0.03）。精算分析显示，与第1组相比，第2组在4年时局部复发率显著降低（P = 0.03），粗生存率有所提高（P = 0.03）。全直肠系膜切除术可降低直肠癌切除术后的局部复发率。
