Luna-Pérez P, Rodríguez D F, Luján L, Alvarado I, Kelly J, Rojas M E, Labastida S, González J L
Surgical Oncology Department, Oncology Hospital, Mexican Social Security Institute, México City.
J Surg Oncol. 1998 Sep;69(1):36-40. doi: 10.1002/(sici)1096-9098(199809)69:1<36::aid-jso7>3.0.co;2-l.
Colorectal sarcomas (CRS) are rare and their treatment remains controversial, especially for those located in the rectum. The aim of this paper is to evaluate our experience, with special emphasis on the failure pattern after surgical therapy alone or combined with postoperative radiotherapy.
The medical records and histological slides of 13 CRS patients treated between 1986 and 1996 were reviewed retrospectively.
The patients included eight males and five females, with a median age of 54 years; nine of their primary tumors were located in the rectum, and four in the colon. The histologies were leiomyosarcoma in nine cases and malignant fibrous histiocytoma in four cases. Surgical treatment consisted of anatomical colectomy (four); local excision (three); abdominoperineal resection (APR)(two); low anterior resection (LAR)(two); LAR en bloc with the prostate (one), and total pelvic exenteration (one). One operative death occurred. The median size of the tumors was 8 cm (range, 5-40). The tumors were graded as low, three, and high, ten. The median follow-up was 24 months. Eight patients in the overall group developed recurrences as follows: local, three; local and distant, three, and distant, two. Five out of nine patients with rectal sarcoma received adjuvant postoperative radiotherapy (PRT). Local recurrence occurred in 20% (1/5) of those who received PRT, and in 100% (3/3) of those who did not. The overall 5-year survival was 40%, and the 5-year survival for patients with low-grade tumors was 66%, as compared with 22% for those with high-grade tumors.
The patterns of failure in CRS are combined in both local and distant sites. However, our results suggest that in rectal sarcoma, the use of surgery + PRT may reduce the local recurrence rate; in selected patients, it may allow for anal sphincter preservation.
结直肠肉瘤（CRS）较为罕见，其治疗仍存在争议，尤其是对于直肠部位的肉瘤。本文旨在评估我们的经验，特别关注单纯手术治疗或联合术后放疗后的失败模式。
回顾性分析1986年至1996年间接受治疗的13例CRS患者的病历和组织学切片。
患者包括8例男性和5例女性，中位年龄54岁；其中9例原发肿瘤位于直肠，4例位于结肠。组织学类型为平滑肌肉瘤9例，恶性纤维组织细胞瘤4例。手术治疗包括解剖性结肠切除术（4例）；局部切除术（3例）；腹会阴联合切除术（APR）（2例）；低位前切除术（LAR）（2例）；LAR联合前列腺整块切除（1例），以及全盆腔脏器切除术（1例）。发生1例手术死亡。肿瘤中位大小为8 cm（范围5 - 40 cm）。肿瘤分级为低级别3例，高级别10例。中位随访时间为24个月。总体组中有8例患者出现复发，情况如下：局部复发3例；局部及远处复发3例，远处复发2例。9例直肠肉瘤患者中有5例接受了术后辅助放疗（PRT）。接受PRT的患者中20%（1/5）发生局部复发，未接受PRT的患者中100%（3/3）发生局部复发。总体5年生存率为40%，低级别肿瘤患者的5年生存率为66%，而高级别肿瘤患者为22%。
CRS的失败模式包括局部和远处部位。然而，我们的结果表明，对于直肠肉瘤，手术 + PRT的应用可能降低局部复发率；在部分患者中，可能允许保留肛门括约肌。
