Heald R J, Moran B J, Ryall R D, Sexton R, MacFarlane J K
Colorectal Research Unit, The North Hampshire Hospital, Basingstoke, Hampshire, England.
Arch Surg. 1998 Aug;133(8):894-9. doi: 10.1001/archsurg.133.8.894.
To examine the role of total mesorectal excision in the management of rectal cancer.
A prospective consecutive case series.
A district hospital and referral center in Basingstoke, England.
Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation.
Anterior resections (n = 465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal resections (n = 37), Hartmann resections (n = 10), local excisions (n = 4), and laparotomy only (n = 3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal resections, 38 with anterior resections, 3 with Hartmann resections, and 1 with laparotomy).
Local recurrence and cancer-specific survival.
Cancer-specific survival of all surgically treated patients was 68% at 5 years and 66% at 10 years. The local recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence interval, 2%-14%) at 10 years. In 405 "curative" resections, the local recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence interval, 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years and 78% at 10 years. An analysis of histopathological risk factors for recurrence indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as variables in these results.
Rectal cancer can be cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all stages and in 4 of 5 patients having curative resections. In future clinical trials of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal excision as the surgical procedure of choice.
探讨全直肠系膜切除术在直肠癌治疗中的作用。
前瞻性连续病例系列研究。
英国贝辛斯托克的一家地区医院及转诊中心。
519例接受根治性或姑息性治疗的直肠腺癌手术患者。
低位吻合的前切除术（n = 465例，其中407例行全直肠系膜切除术）、腹会阴联合切除术（n = 37例）、Hartmann切除术（n = 10例）、局部切除术（n = 4例）以及仅行剖腹术（n = 3例）。49例患者（7例行腹会阴联合切除术、38例行前切除术、3例行Hartmann切除术、1例行剖腹术）接受了术前放疗。
局部复发和癌症特异性生存率。
所有接受手术治疗患者的癌症特异性生存率在5年时为68%，10年时为66%。局部复发率在5年时为6%（95%置信区间，2% - 10%），10年时为8%（95%置信区间，2% - 14%）。在405例“根治性”切除术中，局部复发率在5年时为3%（95%置信区间，0% - 5%），10年时为4%（95%置信区间，0% - 8%）。该组无病生存率在5年时为80%，10年时为78%。对复发的组织病理学危险因素分析表明，在这些结果中仅Dukes分期、壁外血管侵犯和肿瘤分化为变量。
在所有分期接受手术切除的患者中，三分之二可通过单纯手术治愈；在接受根治性切除的患者中，五分之四可通过单纯手术治愈。在未来辅助化疗和放疗的临床试验中，策略应将全直肠系膜切除术作为首选手术方式。
