AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative res...AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.展开更多
Objective:To investigate the difference and complementarity between total mesorectal excision(TME)and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rec...Objective:To investigate the difference and complementarity between total mesorectal excision(TME)and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer.Methods:Clinical data of 81 cases during a period from 1975 to 2001 were retrospectively analyzed.Results:In the 81 cases with local recurrence,49 of them laid to anastomosis and mesorectum,17 lymph nodes and 15 multi-site relapse.The choice of operative procedure included abdominoperineal resection in 58 cases,Hartmann’s operation in 4 cases,simple double-pelvic stoma in 12 cases,exploration in 7 cases,and total pelvic or rear-pelvic resection in combination with other organs in 6 cases. The rate of resection was 84.0%(68/81).32 cases reached clinical radical degree,and the rate of radical resection was 39.5% (32/81).The 5-year survival rate was 34.4%(11/32).Conclusion:Based on actual condition of the patients,attention to radi- cal resection and total mesorectal excision are necessary,and reasonable adoption of the operative procedure could reduce the local recurrence of rectal cancer.展开更多
AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, medi...AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum -those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour-free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.展开更多
基金The WST Foundation of Guangdong Province, No. 2000112736580706003
文摘AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.
文摘Objective:To investigate the difference and complementarity between total mesorectal excision(TME)and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer.Methods:Clinical data of 81 cases during a period from 1975 to 2001 were retrospectively analyzed.Results:In the 81 cases with local recurrence,49 of them laid to anastomosis and mesorectum,17 lymph nodes and 15 multi-site relapse.The choice of operative procedure included abdominoperineal resection in 58 cases,Hartmann’s operation in 4 cases,simple double-pelvic stoma in 12 cases,exploration in 7 cases,and total pelvic or rear-pelvic resection in combination with other organs in 6 cases. The rate of resection was 84.0%(68/81).32 cases reached clinical radical degree,and the rate of radical resection was 39.5% (32/81).The 5-year survival rate was 34.4%(11/32).Conclusion:Based on actual condition of the patients,attention to radi- cal resection and total mesorectal excision are necessary,and reasonable adoption of the operative procedure could reduce the local recurrence of rectal cancer.
文摘AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum -those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour-free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.
