Arbogast H, Fürst H, Schildberg F W
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern.
Chirurg. 1996 Jun;67(6):625-9.
In a retrospective analysis, 140 patients with locoregional recurrence of rectal carcinoma were investigated in respect of prognostic factors. Neither classification of the primary tumor nor adjuvant therapies showed any significant influence on long-term survival, calculated according to the Cutler-Ederer method. The 3-(5-) year probability of survival of 52 (18) % is significantly better in cases with local curative operations than the 3 (0) % in cases with local palliative operations. Therefore, early indication for a possible radical resection of the recurrent tumor is essential. In 37.1%, local curative operations could be performed. The probability of long-term survival is significantly influenced by the kind of recurrence. Patients with local recurrence (anastomosis) after primary resection have the best prognosis with a 84 (33) % 3-(5-) year probability of survival. Independent of the kind of primary operation, the survival data on the remainder of patients after local curative operation for recurrent tumors are comparable. They are, however, still better than for non-curative operations. The striking differences in perioperative mortality (3 months) with regards to therapeutic intention (25% for local palliative operations without resection, 7.1% in cases of palliative surgery with resection and 1.9% in cases with local curative operations) must result in criteria for resectability being determined preoperatively on the basis of intensive diagnostic measures. Thus, the rate of palliative operations without benefit for the patient may be minimized.
在一项回顾性分析中，对140例直肠癌局部区域复发患者的预后因素进行了研究。根据卡特勒 - 埃德勒方法计算，原发肿瘤的分类和辅助治疗对长期生存均未显示出任何显著影响。局部根治性手术患者的3（5）年生存率为52（18）%，明显优于局部姑息性手术患者的3（0）%。因此，对于复发性肿瘤可能进行根治性切除的早期指征至关重要。37.1%的患者能够进行局部根治性手术。长期生存概率受复发类型的显著影响。初次切除后局部复发（吻合口）的患者预后最佳，3（5）年生存率为84（33）%。无论原发手术类型如何，复发性肿瘤局部根治性手术后其余患者的生存数据具有可比性。然而，它们仍优于非根治性手术。围手术期死亡率（3个月）在治疗意图方面存在显著差异（未切除的局部姑息性手术为25%，姑息性切除手术为7.1%，局部根治性手术为1.9%），这必须促使在术前基于强化诊断措施确定可切除性标准。这样，对患者无益的姑息性手术率可能会降至最低。
