局部复发直肠癌187例手术疗效及预后因素分析

Surgical outcomes for 187 patients with locally recurrent rectal cancer and analysis of prognostic factors

目的探讨局部复发直肠癌（LRRC）患者的手术疗效及预后影响因素。方法回顾性分析1985年1月至2009年12月北京大学第一医院手术治疗的187例LRRC患者的病例资料。结果行局部切除术34例，腹会阴联合切除术35例，后盆腔脏器切除术17例，全盆腔脏器切除术（TPE）98例，TPE联合骶尾骨切除2例，TPE联合半骨盆切除1例。R0、R1、R2切除分别为87、60、40例；手术根治性与初次手术方式及盆壁受侵固定程度有关（P〈0．05）。手术并发症发生率为47．5％（89／187），围手术期死亡率2．7％（5／187），术后局部复发率44．4％（64／144）。144例术后3、5年生存率分别为42．2％和30．7％，手术根治性和淋巴结转移是影响预后的独立危险因素（P〈0．01）。R0、R1与R2切除者5年生存率分别为42．6％、17．2％和0（P〈0．01）；淋巴结转移阴性与阳性者5年生存率分别为40．5％与5．6％（P〈0．01）。结论术前准确评估肿瘤固定范围、提高R0切除率是提高LRRC患者手术疗效的关键。

Objective To evaluate the surgical outcomes for patients with locally recurrent rectal cancer （LRRC） and to analyze the prognostic factors. Methods Clinical data of 187 patients with LRRC undergoing surgery at the First Hospital of peking University from January 1985 to December 2009 were retrospectively reviewed. Results Procedures performed included local resection （n=34）, abdominoperineal resection （n=35）, posterior pelvic exenteration （n=17）, total pelvic exenteration（TPE, n=98）, TPE with sacrectomy （n=2）, and TPE with internal hemipelveetomy （n=1）. The operation was R0 in 87 patients, R1 in 60, and R2 in 40. The degree of radical resection was associated with the initial surgery and the degree of pelvic fixation（P〈0.05）. The pelvic recurrence rate was 44.4%（64/144）. The operative morbidity and mortality were 47.5%（89/187） and 2.7% （5/187）, respectively. The overall 3- and 5-year survival rates were 42.2% and 30.7%, respectively. The degree of radical resection and lymph node metastasis were independent risk factors associated with prognosis. The 5-year survival rates of R0, R1 and R2 were 42.6%, 17.2% and 0, respectively （P〈0.01）. The 5-year survival rates of patients with and without lymph node metastasis were 5.6% and 40.5% （P〈0.01） respectively. Conclusion Accurate evaluation of extent of pelvic fixation and achievement of R0 resection are critical to improve the surgical outcomes for LRRC.