Salvage therapy for pelvic recurrence following curative rectal cancer resection
Salvage therapy for pelvic recurrence following curative rectal cancer resection
复制标题
根治性直肠癌切除术后盆腔复发的挽救治疗
DOI：
--
复制
发表时间：
1997
影响因子：
3.9
通讯作者：
A. Cohen
中科院分区：
文献类型：
--
作者：
J. Cunningham;W. Enker;A. Cohen
引言：盆腔复发是直肠癌根治性切除术后的一个重要问题。虽然治疗方案包括手术、化疗、放疗或任何这些的组合，但手术在这些患者的管理中的作用仍然存在争议。目得：在这项研究中，我们试图确定患者盆腔复发后，根治性直肠手术谁可能受益于再切除。方法：纪念斯隆-凯特琳癌症中心（MSKCC）前瞻性结直肠数据库的综述在1983年至1991年期间，确定了25例直肠癌根治性切除术后盆腔复发的患者和52例初次直肠手术的患者，外部机构（OI）和他们的盆腔复发在MSKCC治疗。采用Kaplan-Meier法从复发时间计算生存率，并采用对数秩分析进行生存率比较。两组之间在年龄、性别、初次手术类型、分期或辅助治疗的使用方面没有差异。结果：对于MSKCC组，首次复发的中位时间为18个月，中位生存期为40个月。17例患者复发为症状性复发，8例患者无症状。疼痛和出血占症状性复发的一半以上。在17例症状性复发中，11例（65%）术前症状缓解。没有发现原发肿瘤或复发的临床或病理因素可以预测挽救治疗后生存率的提高。术前无法确定哪些患者可以进行根治性再切除。对于OI组，中位复发时间为13.7个月，从首次复发开始的中位生存期为31个月。与非治愈性治疗相比，治愈性再切除是预测生存率提高的唯一因素（P= 0.02）。两组比较，盆腔复发率OI组较MSKCC组更容易再次切除治愈（34/51 vs.9/25;P <0.02）。在比较这些患者的治疗性和非治疗性管理时，两组之间的生存率没有差异。结论：复发性直肠癌的症状可以通过手术缓解。唯一有生存获益的患者是OI组中疾病可以完全切除的患者。再切除率的这些差异可能归因于阻乳症组中复发周围是否存在可用的解剖平面，这由初始治愈性切除的方法确定。
INTRODUCTION: Pelvic recurrence is a significant problem following curative resection for rectal cancer. Although treatment options include surgery, chemotherapy, radiotherapy, or any combination of these, the role of surgery remains controversial in management of these patients. PURPOSE: In this study, we have attempted to define the patient with pelvic recurrence following curative rectal surgery who may benefit from reresection.METHODS: A review of the prospective colorectal database at Memorial Sloan Kettering Cancer Center (MSKCC) between 1983 and 1991 identified 25 patients who had pelvic recurrence following a curative resection for rectal cancer and 52 patients who had their initial rectal surgery at an outside institution (OI) and their pelvic recurrence treated at MSKCC. Survival was calculated from time of recurrence by the Kaplan-Meier method, and survival comparisons were made by log-rank analysis. There were no differences between the two groups related to age, gender, type of initial surgery, stage, or use of adjuvant therapy. RESULTS: For the MSKCC group, median time to initial recurrence was 18 months, and median survival was 40 months. Recurrence was symptomatic in 17 patients and asymptomatic in 8 patients. Pain and bleeding accounted for more than one-half of symptomatic recurrences. Of the 17 symptomatic recurrences, 11 (65 percent) had relief of preoperative symptoms. There were no clinical or pathologic factors identified of the primary tumor or recurrence that predicted improved survival following salvage therapy. It was not possible to preoperatively determine which patients could undergo curative reresection. For the OI group, median time to recurrence was 13.7 months, and median survival from time of initial recurrence was 31 months. Curative reresection was the only factor that predicted for improved survival compared with noncurative treatment (P= 0.02). A comparison of the two groups revealed that pelvic recurrence was more likely to be reresected for cure in the OI groupvs.the MSKCC group (34/51vs.9/25;P <0.02). There was no survival difference between the two groups when comparing curative with noncurative management of these patients. CONCLUSIONS: Symptoms from recurrent rectal cancer can be palliated with surgery. The only patients who had a survival benefit were those patients in the OI group whose disease could be completely resected. These differences in reresection rates may be attributable to the presence or absence of available planes for dissection around the recurrence in the OI group, as determined by the method of initial curative resection.
DOI：
10.1001/jama.1993.03510080047030
发表时间：
1993-08
期刊：
JAMA
影响因子：
--
作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
通讯作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
影响因子：
8.4
作者：
Witkamp, AJ;de Bree, E;Zoetmulder, FAN
通讯作者：
Zoetmulder, FAN
影响因子：
3.8
作者：
Michelassi,F;Vannucci,L;Ayala,JJ;Chappel,R;Goldberg,R;Block,GE
通讯作者：
Block,GE