Radice E, Nelson H, Devine R M, Dozois R R, Nivatvongs S, Pemberton J H, Wolff B G, Fozard B J, Ilstrup D
Mayo Clinic and Mayo Foundation, Division of Colon and Rectal Surgery, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 1998 Jan;41(1):11-7. doi: 10.1007/BF02236889.
When colorectal cancer complicates chronic ulcerative colitis or familial adenomatous polyposis, the role of ileal pouch-anal anastomosis is uncertain because of concerns that the procedure may compromise oncologic therapy and that oncologic therapy may compromise ileal pouch-anal anastomosis function.
This study was undertaken to investigate the impact both of ileal pouch-anal anastomosis on cancer outcomes and of cancer treatments on ileal pouch-anal anastomosis function.
Of 1,616 patients undergoing ileal pouch-anal anastomosis for chronic ulcerative colitis or familial adenomatous polyposis (1981-1994), 77 patients were identified with adenocarcinoma of the colon (56), rectum (17), or both (4). Data were obtained from an ileal pouch-anal anastomosis registry, case notes, and postal and telephone surveys.
Mean age of the 77 index patients was 37 (range, 13-60) years. Stage distribution was as follows: Stage 0, 9; Stage I, 31; Stage II, 15; Stage III, 22 patients. Twelve patients died with systemic disease (6 with a local component) after a mean follow-up of 6 (range, 2-15) years. Twenty-two patients received adjuvant therapy (chemotherapy, 16; radiotherapy, 2; both, 4 patients). Chemotherapy complications requiring dose reduction or interruption occurred in three (15 percent) patients. One patient developed radiation enteritis (17 percent). Pouch failure occurred in 16 percent of cancer patients, compared with 7 percent for the overall registry. There were no differences between cancer and non-cancer groups in operative complications, median stool frequency, incontinence, pad usage, or pouchitis.
Although pouch failure is more common, ileal pouch-anal anastomosis can be performed in the setting of colorectal cancer without significant impact on oncologic outcome or long-term ileal pouch-anal anastomosis function.
当结直肠癌并发慢性溃疡性结肠炎或家族性腺瘤性息肉病时，由于担心该手术可能会影响肿瘤治疗，且肿瘤治疗可能会损害回肠储袋肛管吻合术的功能，因此回肠储袋肛管吻合术的作用尚不确定。
本研究旨在调查回肠储袋肛管吻合术对癌症结局的影响以及癌症治疗对回肠储袋肛管吻合术功能的影响。
在1981年至1994年间因慢性溃疡性结肠炎或家族性腺瘤性息肉病接受回肠储袋肛管吻合术的1616例患者中，有77例被确诊患有结肠癌（56例）、直肠癌（17例）或两者皆有（4例）。数据来自回肠储袋肛管吻合术登记处、病历记录以及邮寄和电话调查。
77例索引患者的平均年龄为37岁（范围13 - 60岁）。分期分布如下：0期9例；I期31例；II期15例；III期22例。平均随访6年（范围2 - 15年）后，12例患者死于全身性疾病（6例伴有局部病变）。22例患者接受了辅助治疗（化疗16例；放疗2例；放化疗联合4例）。3例（15%）患者出现需要减少剂量或中断化疗的并发症。1例患者发生放射性肠炎（17%）。癌症患者中储袋功能衰竭发生率为16%，而整个登记处的发生率为7%。癌症组和非癌症组在手术并发症、中位排便频率、失禁、护垫使用或袋炎方面无差异。
尽管储袋功能衰竭更为常见，但在结直肠癌患者中仍可进行回肠储袋肛管吻合术，且对肿瘤结局或回肠储袋肛管吻合术的长期功能无显著影响。
