Ogunbiyi O A, McKenna K, Birnbaum E H, Fleshman J W, Kodner I J
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Dis Colon Rectum. 1997 Feb;40(2):150-5. doi: 10.1007/BF02054979.
The purpose of this study was to determine whether radical surgery in appropriately selected patients who have recurrent rectal cancer can produce significant disease-free survival.
This is a retrospective review of the management of all patients presenting with recurrent local and metastatic rectal cancer at a single institution during an 11-year period.
Of 489 patients who underwent curative surgery for primary rectal cancer during the period reviewed, 44 (9 percent) developed recurrent disease at a median interval of 18 (range, 3-60) months after curative surgery. Local pelvic recurrence alone was present in 28 (5.7 percent) patients. Overall survival after diagnosis of recurrent disease was 41 percent (18/44) at a median interval of 15 (range, 2-60) months. Curative resection was performed in 14 (32 percent) patients with a disease-free survival of 86 percent (12/14) at a median of 25 (range, 9-60) months after curative surgery. In comparison, survival in patients who underwent palliative treatment was significantly less (25 vs. 12 months; P < 0.05; 95 percent confidence interval, 10, 23 (Mann-Whitney U test)); 20 percent survival at a median of 12 months ranged from 2 to 36 after diagnosis of recurrent disease. Of six patients in the curative group who developed second recurrences, four underwent further curative surgery and are disease-free at a median of 19.5 (range, 12-29) months after surgery. Palliative surgery provided good symptomatic relief and improved quality of life in 11 patients in the palliative group, although there was no survival advantage over those who underwent nonsurgical palliative treatment (n = 19).
In appropriately selected cases, aggressive surgical therapy produces significant disease-free survival in patients with recurrent rectal cancer.
本研究旨在确定对经适当选择的复发性直肠癌患者进行根治性手术是否能产生显著的无病生存期。
这是一项对某单一机构在11年期间收治的所有复发性局部和转移性直肠癌患者的治疗情况进行的回顾性研究。
在回顾期间接受原发性直肠癌根治性手术的489例患者中，44例（9%）出现复发性疾病，根治性手术后复发的中位间隔时间为18个月（范围3 - 60个月）。仅局部盆腔复发的患者有28例（5.7%）。复发性疾病诊断后的总生存率为41%（18/44），中位间隔时间为15个月（范围2 - 60个月）。14例（32%）患者接受了根治性切除，根治性手术后的无病生存率为86%（12/14），中位时间为25个月（范围9 - 60个月）。相比之下，接受姑息性治疗的患者生存期明显较短（25个月对12个月；P < 0.05；95%置信区间为10, 23（曼-惠特尼U检验））；复发性疾病诊断后，中位生存期为12个月时的生存率为20%，范围为2至36个月。在根治性治疗组中出现二次复发的6例患者中，4例接受了进一步的根治性手术，术后中位无病时间为19.5个月（范围为12 - 29个月）。姑息性手术在姑息性治疗组的11例患者中提供了良好的症状缓解并改善了生活质量，尽管与接受非手术姑息性治疗的患者（n = 19）相比没有生存优势。
在适当选择的病例中，积极的手术治疗可使复发性直肠癌患者获得显著的无病生存期。
