肛管表皮癌保守治疗失败后的补救性经腹会阴切除术

PURPOSE: Radiotherapy alone or with combined chemot-herapy is the first therapeutic option for epidermoid carcinoma of the anal canal. Failure of this conservative treatment may benefit of salvage abdominoperineal resection. This study was designed to analyze postoperative outcome and oncologic results in a single anticancer institution. METHODS: Medical charts of 36 patients (median age, 57.9 years) who underwent salvage abdominoperineal resection after failure of conservative treatment between 1987 and 2002 were reviewed retrospectively. There were 15 patients treated for immediate failure (Group I) and 21 patients for recurrence (Group II). Twenty-two patients have undergone primary use of flap reconstruction of the perineal wound. There were ten rectus abdominis myocutaneous flaps, nine omental flaps, two gracilis muscular flaps, and one combined flap. RESULTS: There was no postoperative mortality. Median follow-up was 67 (range, 15-155) months. Primary closure of the perineum was obtained in 33 patients (92 percent). Secondary wound breakdown occurred in 23 of 33 patients (70 percent). Complications unrelated to the perineal wound occurred in 13 patients. The overall crude five-year survival after salvage abdominoperineal resection was 69.4 percent. The crude five-year survival in Group I and Group II was 60.7 and 71.5 percent respectively (P = 0.28). The crude five-year, disease-free survival in Groups I and II was 31.1 and 48.2 percent respectively (P = 0.10). Twenty-three patients experienced recurrences after salvage abdominoperineal resection (64 percent) with a mean delay of 30 months. CONCLUSIONS: Despite high incidence of perineal morbidity, salvage abdominoperineal resection for epidermoid carcinomas of the anal canal has a high long-term survival rate.

胃贲门局部进展期腺癌:术前化放疗效果

Overall prognosis of adenocarcinomas of the gastro-esophageal junction remains poor as most patients present with advanced disease. Aim-To examine the effects of preoperative chemoradiotherapy in locally advanced adenocarcinomas of the gastro-esophageal junction. Methods-Forty-two consecutive patients received a course of radiotherapy (45 Gy, administred in 25 fractions) with concurrent infusion of 5-fluorouracil and cisplatin, followed by surgery. Endoscopic ultrasonography was used to assess response to chemoradiotherapy. A transhiatal or a transthoracic approach was used for surgical resection. Tumor size, node invasion and margins of resection were analyzed. Results-Thirty-eight patients underwent subsequent surgery and complete resection (R0) was achieved in 34. Operative mortality was 13.2%(5/38). A his -tological complete response was observed in 6 patients. Median survival was 23 months (range: 15-31) and median disease-free survival was 19 months (range: 15-23). At one and two years, 70.7 and 45.6%of the patients were alive, respec tively. The pTNM status, node involvement and tumor size were predictors of survival. Conclusions -Pre-operative chemoradiotheropy is effective in patients with locally advanced carcinoma of the gastro-esophageal junction, resulting in high resection rates. However it seems to increase operative morbidity and mortality. Certain prognostic factors such as resection margins, need to be examined in further detail.

胰腺导管腺癌的新辅助放化疗后行超声内镜的术前局部评估

Introduction-The accuracy of endoscopic ultrasound (EUS)for the diagnosis and staging of pancreatic ductal adenocarcinoma (PDA) has been confirmed. Chemoradiotherpay (CRT) induces tumor changes which can limit the accuracy of EUS. The aim of our study was to analyze the efficacy of EUS following neoadjuvant CRT comparing findings with the pathology results. Patients and methods-From November 1996 to October 2003, 45 patients with histologically proven and EUS-staged PDA were treated with neoadjuvant CRT and radical surgery. All were restaged before surgery using both EUS and computed tomography. Fifteen patients were found to hove developed distant metastases. Thirty patients finally underwent pancreaticoduodenectomy (N = 24) or distal pancreatectomy (N = 6). Results - Following CRT, tumor stage was correctly assessed in 12 patients (40% ). The most frequent misinterpretation was overestimation of tumor size (N = 13, 43.3% ). Locoregional vascular invasion of veins was suspected by EUS in 13 patients (43.3% ) but surgical findings and the histological examination were both negative. Node status was correctly assessed in 27 patients (90% ) but nodal involvement was found on the histological specimen in only 3 patients. Conclusion - Preoperative EUS after neoadjuvant CRT for PDA does not enable reliable definitive selection of patients for surgery, probably due to radiation- induced pancreatic changes.