Taylor R H, Hay J H, Larsson S N
Division of Surgery, British Columbia Cancer Agency, Vancouver Cancer Center, Canada.
Am J Surg. 1998 May;175(5):360-3. doi: 10.1016/S0002-9610(98)00038-5.
To determine if transanal local excision (TALE) of selected early low rectal cancer is an effective alternative to more radical resection and to determine the need for adjuvant radiotherapy in these patients.
A retrospective analysis of all 47 cases referred for consideration of radiotherapy after TALE for low rectal cancer.
Indications for TALE were elective, 32; concurrent medical problems, 11; and refusal of radical resection, 4. Median follow-up was 52 months. Local recurrence occurred in 7 of 27 T1 cases, 5 of 17 T2, and 2 of 3 T3. Three of 23 irradiated patients developed local recurrence, compared with 11 of 24 unirradiated (P = 0.023). Of 28 cases with favorable histological features, 1 of 13 irradiated patients developed local recurrence, compared with 4 of 16 unirradiated (P = 0.22). Seven patients had salvage resection, and 3 of these are alive with no evidence of disease at 21, 39, and 71 months postsalvage. Recurrence-free survival at 5 years was 81 % in the irradiated patients and 52% in the unirradiated (P = 0.025).
Transanal local excision of selected low rectal cancers, combined with adjuvant radiotherapy, results in a low recurrence rate and is, therefore, an effective alternative to more radical resection.
确定对部分早期低位直肠癌行经肛门局部切除（TALE）是否是更根治性切除的有效替代方法，并确定这些患者是否需要辅助放疗。
对所有47例行TALE治疗低位直肠癌后考虑放疗的病例进行回顾性分析。
TALE的适应证为选择性手术32例；并存内科疾病11例；拒绝根治性切除4例。中位随访时间为52个月。27例T1期病例中有7例局部复发，17例T2期中有5例，3例T3期中有2例。23例接受放疗的患者中有3例发生局部复发，而24例未接受放疗的患者中有11例（P = 0.023）。在28例组织学特征良好的病例中，13例接受放疗的患者中有1例发生局部复发，而16例未接受放疗的患者中有4例（P = 0.22）。7例患者接受挽救性切除，其中3例在挽救性切除后21、39和71个月时存活且无疾病证据。接受放疗的患者5年无复发生存率为81%，未接受放疗的患者为52%（P = 0.025）。
对部分低位直肠癌行经肛门局部切除并联合辅助放疗，复发率低，因此是更根治性切除的有效替代方法。
