对于上段直肠癌，全直肠系膜切除术并非必要。
Total mesorectal excision is not necessary for cancers of the upper rectum.
作者信息
Lopez-Kostner F, Lavery I C, Hool G R, Rybicki L A, Fazio V W
机构信息
Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, OH 44195, USA.
出版信息
Surgery. 1998 Oct;124(4):612-7; discussion 617-8. doi: 10.1067/msy.1998.91361.
BACKGROUND
The technical aspects of surgery of the upper rectum (10 to 15 cm from the anal verge) and sigmoid colon are similar, but a change in technique is required for surgery of the lower rectum (< 10 cm). The aim of this study was to compare the outcomes of the treatment of upper rectal cancer (UR), in which total mesorectal excision (TME) was not performed, with outcomes of sigmoid colon cancers (S) and lower rectal cancers (LR).
METHODS
Between 1980 and 1990, 891 patients were treated with curative intent for sigmoid (n = 225) and rectal cancer (UR = 229; LR = 437). The Kaplan-Meier and Cox proportional hazards analyses were used to compare outcomes.
RESULTS
The risk of local recurrence alone, local and distant recurrence, death as a result of cancer, or any recurrence or death as a result of cancer was 3.5, 2.7, 2.1, and 1.9 times higher for patients with LR than for patients with UR, but the risk was not increased for UR relative to S.
CONCLUSIONS
The outcome of treatment for UR is the same as for S and differs favorably from that for LR. UR should be treated by the same technique as S.
背景
直肠上段（距肛缘10至15厘米）和乙状结肠手术的技术层面相似，但直肠下段（<10厘米）手术需要技术上的改变。本研究的目的是比较未进行全直肠系膜切除术（TME）的直肠上段癌（UR）与乙状结肠癌（S）和直肠下段癌（LR）的治疗结果。
方法
1980年至1990年间，891例患者接受了乙状结肠癌（n = 225）和直肠癌（UR = 229；LR = 437）的根治性治疗。采用Kaplan-Meier法和Cox比例风险分析来比较结果。
结果
LR患者单独局部复发、局部和远处复发、因癌症死亡或因癌症导致的任何复发或死亡的风险分别是UR患者的3.5倍、2.7倍、2.1倍和1.9倍，但UR相对于S患者风险并未增加。
结论
UR的治疗结果与S相同，且优于LR。UR应采用与S相同的技术进行治疗。
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