同时性多原发大肠癌的外科治疗及预后因素分析

Therapeutic options and prognosis of synchronous multiple primary colorectal carcinomas

目的探讨同时性多原发大肠癌(SCC)的外科治疗方法及其预后因素。方法对手术治疗的66例SCC患者的临床资料进行回顾性研究,并结合随访资料进行生存分析。结果除1例首治时漏诊,其余均同期手术切除。其中根治性切除62例,姑息性切除3例;一并切除30例,分段切除35例。总的3,5,10年生存率分别为70.3%、60.0%和40.6%,其中同期根治性切除患者的3,5,10年生存率分别为76.0%、65.9%和46.4%。结论SCC的手术治疗并无固定模式,需根据肿瘤的位置、范围、间距以及患者的综合情况等决定。对于符合遗传性非息肉病性大肠癌诊断的患者应考虑全结肠或次全结肠切除术,以减少或避免异时性多原发大肠癌的发生。SCC的外科治疗效果并不比普通大肠癌差。

Objective To investigate the therapeutic principles and prognosis of synchronous primary colorectal carcinomas （SCC）. Methods The data of 66 SCC patients surgically treated from 1984 to 2003 were retrospectively reviewed. Results The synchronous primary colorectal carcinomas were diagnosed and resected simultaneously in 65 patients except one that was misdiagnosed. Thirty patients underwent combined resection, 35 patients segmental resection. Sixty-two patients received radical resection, while three patients had palliative resection due to hepatic metastasis. The overall postoperative 3-, 5-, 10-year survival rates were 70.3% ,60.0%,40.6%, respectively. In the patients who had simultaneous radical resection, the 3-, 5-, 10-year survival rates were 76.0%, 65.9%, 46.4% respectively. Conclusion The extent of resection should be individually determined by the lesion location, extent and distance between the lesions, as well as the patient＇s general condition. More extensive bowel resection, such as total or subtotal colectomy are suggested for those patients with hereditary nonpolyposis colorectal carcinoma syndrome in order to reduce or avoid the risk of metachronous colorectal carcinoma. The postoperative survival in patients with synchronous primary colorectal carcinoma is similar to those with solitary lesion.