直肠癌局部复发的治疗
Treatment of local recurrence of rectal cancer.
作者信息
Huguier M, Houry S
机构信息
Department of Surgery, Hôpital Tenon, University Paris VI, France.
出版信息
Am J Surg. 1998 Apr;175(4):288-92. doi: 10.1016/s0002-9610(98)00016-6.
BACKGROUND
Treatment of local recurrence of rectal cancer remains a challenge. Preoperative irradiation and total mesorectal excision halve the risks of local failure, but increase morbidity and even mortality. The results of re-resection of recurrent rectal cancer suggest need to reexamine therapeutic strategies for initial treatment.
METHODS
Seventy-one patients operated on for rectal carcinoma without radiotherapy developed local recurrence (29 with metastatic disease). Thirty underwent a curative re-resection (8 had combined resection of metastases).
RESULTS
The incidence of asymptomatic recurrence was higher after anterior resection (38%) than after abdominoperineal resection (16%). The actuarial 5-year survival rate was 19%; 28% in asymptomatic patients and 8% in symptomatic (P = 0.04).
CONCLUSIONS
Early detection of recurrence of rectal cancer leads to an improved re-resection rate and survival. In patients who did not undergo radiotherapy at the time of the original resection, re-resection can be achieved safely. The place for radiation in the treatment of rectal cancer must be redefined.
背景
直肠癌局部复发的治疗仍然是一项挑战。术前放疗和全直肠系膜切除术可将局部复发风险减半，但会增加发病率甚至死亡率。复发性直肠癌再次手术的结果表明需要重新审视初始治疗的策略。
方法
71例未接受放疗的直肠癌手术患者出现局部复发（29例伴有转移性疾病）。30例患者接受了根治性再次手术（8例同时切除了转移灶）。
结果
前切除术术后无症状复发的发生率（38%）高于腹会阴联合切除术（16%）。5年精算生存率为19%；无症状患者为28%，有症状患者为8%（P = 0.04）。
结论
直肠癌复发的早期检测可提高再次手术率和生存率。在初次切除时未接受放疗的患者中，可安全地进行再次手术。必须重新定义放疗在直肠癌治疗中的地位。
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