Long-term survival and recurrence outcomes following surgery for distal rectal cancer.
Long-term survival and recurrence outcomes following surgery for distal rectal cancer.
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DOI：
10.1245/s10434-010-1119-8
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发表时间：
2010-11
影响因子：
3.7
通讯作者：
Chang GJ
中科院分区：
文献类型：
--
作者：
Silberfein EJ;Kattepogu KM;Hu CY;Skibber JM;Rodriguez-Bigas MA;Feig B;Das P;Krishnan S;Crane C;Kopetz S;Eng C;Chang GJ
远端直肠癌的治疗仍然具有临床挑战性，包括直肠切除术和结肠肛门吻合术（CAA）或腹会阴切除术（APR）。本研究的目的是评估与远端直肠癌患者长期生存和局部复发结局相关的手术和病理因素。对1993年至2003年接受根治性切除术的304例远端直肠癌患者进行了回顾性连续队列研究。患者按手术（CAA或APR）分组。采用卡方分析比较人口统计学、病理学、复发和生存数据的比例。生存分析采用Kaplan-Meier法和log-rank检验进行单变量比较，考克斯回归进行多变量比较。肿瘤距肛缘的中位距离为2 cm [四分位距（IQR）0.5-4 cm]。除4例患者外（1例远端，0.3%; 3例桡动脉，1%），所有患者的切缘均为阴性。5年总生存率为82%（pI期88.6%，pII期80.5%，pIII期67.9%）。多变量分析显示，年龄较大、病理分期较晚、淋巴血管或神经周围浸润、治疗期较早和APR手术类型与生存率较差相关。CAA后5年局部复发率为5.3%，APR后为7.9%（p = 0.33）。直肠远端癌采用分期适当的放化疗和CAA或APR直肠切除术治疗后，局部复发率低，总体生存率高。即使远端切缘小于2 cm，也可保留括约肌。
Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer. A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan–Meier method and log-rank test for univariate and Cox regression for multivariate comparison. The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5–4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33). Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.
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影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Thun, Michael J.
通讯作者：
Thun, Michael J.
影响因子：
168.9
作者：
Quirke, Phil;Steele, Robert;Monson, John;Grieve, Robert;Khanna, Subhash;Couture, Jean;O'Callaghan, Chris;Myint, Arthur Sun;Bessell, Eric;Thompson, Lindsay C.;Parmar, Mahesh;Stephens, Richard J.;Sebag-Montefiore, David
通讯作者：
Sebag-Montefiore, David
影响因子：
158.5
作者：
Kapiteijn, E;Marijnen, CAM;van de Velde, CJH
通讯作者：
van de Velde, CJH
影响因子：
3.9
作者：
Heald, RJ;Smedh, RK;Moran, BJ
通讯作者：
Moran, BJ
DOI：
10.1097/01.coc.0000214930.78200.4a
发表时间：
2006-06-01
影响因子：
2.6
作者：
Das, P;Skibber, JM;Crane, CH
通讯作者：
Crane, CH