Saito N, Koda K, Takiguchi N, Oda K, Soda H, Nunomura M, Sarashina H, Nakajima N
First Department of Surgery, Chiba University School of Medicine, Japan.
Int J Colorectal Dis. 1998;13(1):32-8. doi: 10.1007/s003840050128.
This retrospective study evaluated outcome with regard to procedure, local control, and survival after curative surgical resection with and without preoperative radiotherapy for local pelvic recurrence. A total of 58 consecutive patients with local pelvic recurrence of rectal cancer after previous curative resection for primary tumors were reviewed. Of these, 36 underwent both initial resection and follow-up in our department; the remaining 22 had initial surgery and follow-up elsewhere. Of the 58 patients 27 underwent curative re-resection, 9 had palliative resection, and 22 were treated by conservative therapy. Among the 27 patients with curative resection 17 received preoperative radiotherapy (40 Gy) plus surgery and 10 surgery only. No patients were lost to follow-up; median follow-up time was 36.3 months. The overall rate of curative resection was 46.6%: 55.6% in our own follow-up group and 31.8% in the others. With regard to surgical procedure, abdominoperineal resection (APR) with or without sacral resection was standard following previous low anterior resection, and total pelvic exenteration (TPE) with or without sacral resection was common following APR. There was a high incidence of morbidity (71.4%) after TPE. Re-recurrence was observed in 12 (44.4%) after curative re-resection. There was local re-recurrence in 6 (22.2%). The local re-recurrence rate was 11.8% (n = 2) with radiotherapy plus surgery, and 40.0% (n = 4) with surgery alone. The estimated 5-year survival following curative re-resection was 45.6% (61.2% with radiotherapy plus surgery, 29.6% with surgery alone). Both survival and local control with radiotherapy plus surgery tended to be better than with surgery alone. Thus, in selected patients pelvic local recurrence of rectal cancer can be re-resected curably by APR or TPE (with or without sacral resection) combined with preoperative radiotherapy.
这项回顾性研究评估了局部盆腔复发的直肠癌患者在接受根治性手术切除时，无论有无术前放疗，其手术效果、局部控制情况和生存率。对58例先前因原发性肿瘤接受根治性切除后出现局部盆腔复发的连续直肠癌患者进行了回顾性分析。其中，36例在我院接受了初次切除和随访；其余22例在其他地方接受了初次手术和随访。58例患者中，27例行根治性再次切除，9例行姑息性切除，22例接受保守治疗。27例行根治性切除的患者中，17例接受术前放疗（40 Gy）加手术，10例仅接受手术。无患者失访；中位随访时间为36.3个月。根治性切除的总体率为46.6%：我院随访组为55.6%，其他组为31.8%。关于手术方式，在先前低位前切除术后，标准手术为腹会阴联合切除术（APR），可联合或不联合骶骨切除；在APR术后，全盆腔脏器切除术（TPE），可联合或不联合骶骨切除较为常见。TPE术后并发症发生率较高（71.4%）。根治性再次切除术后12例（44.4%）出现再次复发。局部再次复发6例（22.2%）。放疗加手术组局部再次复发率为11.8%（n = 2），单纯手术组为40.0%（n = 4）。根治性再次切除术后估计5年生存率为45.6%（放疗加手术组为61.2%，单纯手术组为29.6%）。放疗加手术组的生存率和局部控制情况均优于单纯手术组。因此，对于部分患者，直肠癌盆腔局部复发可通过APR或TPE（联合或不联合骶骨切除）联合术前放疗进行根治性再次切除。
