局部复发性直肠癌的根治性再次手术

Curative reoperations for locally recurrent rectal cancer.

作者信息

Suzuki K, Dozois R R, Devine R M, Nelson H, Weaver A L, Gunderson L L, Ilstrup D M

机构信息

Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Dis Colon Rectum. 1996 Jul;39(7):730-6. doi: 10.1007/BF02054435.

DOI:10.1007/BF02054435

PMID:8674362

Abstract

PURPOSE

Our aims were to determine the morbidity, survival and its influencing factors, and patterns of failure for patients who underwent further surgery with the hope of cure for locally recurrent rectal cancer.

METHODS

Between January 1981 and December 1988, 224 patients with a preoperative diagnosis of recurrent rectal cancer underwent additional surgery at Mayo Medical Center in Rochester, Minnesota. Of these, 65 underwent further surgery with the hope of cure, i.e., no gross/microscopic residual disease at tumor margins after reoperation. Factors assessed included type of original operation, time interval between operation for primary tumor and initial operation for recurrence, symptom status, degree of fixation, types of reoperations for recurrence, and adjuvant therapy.

RESULTS

None of the patients died within 30 days of reoperation. Seventeen complications requiring hospitalization and/or surgical procedure were observed in 14 patients. Extended operations (involving partial or complete removal of surrounding organs/structures) required more time to perform, a greater number of transfusions, and a longer hospital stay than more limited operations. Three-year, five-year, and median survival were 57, 34, and 44.7 months, respectively. Survival was greater after curative than after palliative resection (P < 0.001). Survival tended to be greater in females (P < 0.075) and in patients without pain (P < 0.065). Cumulative probability of local failure was 24, 41, and 47 percent at 1, 3, and 5 years, respectively. Cumulative risk of distant metastasis was 30, 51, and 62 percent at 1, 3, and 5 years, respectively.

CONCLUSIONS

Our results indicate that complete excision of locally recurrent rectal cancer can provide a significant number of patients with long-term survival and can be accomplished safely in select patients.

摘要

目的

我们的目的是确定那些接受进一步手术以期治愈局部复发性直肠癌的患者的发病率、生存率及其影响因素，以及失败模式。

方法

1981年1月至1988年12月期间，224例术前诊断为复发性直肠癌的患者在明尼苏达州罗切斯特市的梅奥医学中心接受了额外手术。其中，65例患者接受了进一步手术以期治愈，即再次手术后肿瘤边缘无肉眼/显微镜下残留疾病。评估的因素包括初次手术类型、原发性肿瘤手术与复发初次手术之间的时间间隔、症状状态、固定程度、复发再手术类型以及辅助治疗。

结果

没有患者在再次手术后30天内死亡。14例患者出现了17种需要住院和/或手术治疗的并发症。与范围较有限的手术相比，扩大手术（涉及部分或完全切除周围器官/结构）所需的手术时间更长、输血次数更多、住院时间更长。三年、五年和中位生存期分别为57个月、34个月和44.7个月。根治性切除后的生存率高于姑息性切除（P<0.001）。女性患者（P<0.075）和无疼痛患者（P<0.065）的生存率往往更高。局部失败的累积概率在1年、3年和5年时分别为24%、41%和47%。远处转移的累积风险在1年、3年和5年时分别为30%、51%和62%。