原发和复发直肠癌行全盆腔脏器切除术的疗效分析(英文)

Outcome of total pelvic exenteration for local advanced primary and recurrent rectal cancer

目的探讨局部进展期原发和复发直肠癌(locallyadvancedrectalcancer,LARC)行全盆腔脏器切除术(totalpelvicexenteration,TPE)的疗效。方法对1989￣2003年行TPE的28例原发癌和35例复发癌进行回顾性分析。结果全组根治性切除率85.7%,其中原发癌组92.9%,复发癌组80.0%。术后病理证实原发癌组盆腔脏器/组织受侵率67.9%,复发癌组盆腔脏器/组织受侵率100%。原发癌组仅14.3%侵犯盆壁组织;而复发癌组80.0%侵犯达盆壁组织。原发癌组、复发癌组手术死亡率分别为0、2.9%,术后并发症率分别为32.1%、51.4%。全组术后复发率68.4%、原发癌组61.5%、复发癌组72.0%。复发癌组盆腔局部复发率48.0%,高于原发癌组的15.4%(P<0.05)。全组术后5年生存率23.7%,原发癌组、复发癌组分别为38.5%、16.0%(P>0.05)。结论TPE是治疗LARC的有效方法,尽可能行根治性切除是改善LARC尤其是复发癌预后的关键。

To evaluate the benefit of total pelvic exenteration (TPE) in the treatment of primary and recurrent local advanced rectal cancer (LARC). Clinical data of 28 patients with primary LARC and 35 patients with recurrent LARC who underwent TPE between 1989 and 2003 were analyzed retrospectively. Radical resection was performed in 85.7% of all cases, 92.9% of primary cases and 80.0% of recurrent cases. Histologically evidence for pelvic organs/structures involvement was seen in 67.9% of primary cases, while in 100% of recurrent cases. Only 14.3% primary cancers invaded pelvic walls, compared with 80.0% recurrent cancers. Operative mortality was 0 and 2.9% in primary cases and recurent cases respectively, morbidity was 32.1% and 51.4% respectively. Recurrence occurred in 68.4% of all cases, 61.5% of primary cases and 72.0% of recurrent cases. Pelvic local recurrence rate was 15.4% in primary cases and 48.0% in recurrent cases (P <0.05). The 5-year survival rate was 23.7% in all patients, 38.5% in patients with primary LARC, and 16.0% in patients with recurrent LARC (P >0.05). [Conclusion] TPE is an effective treatment option for LARC. The achievement of radical resection is the guarantee of better outcome for patients with LARC, especially those with recurrent cancer.