Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy
Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy
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直肠腺癌“治愈性手术”后再次手术（第二次或症状性检查）时发现的失败区域：临床病理学相关性和对辅助治疗的影响
作者：
L. Gunderson;H. Sosin
在明尼苏达大学，75例在初始“根治性手术”时肠壁完全穿透和/或淋巴结阳性的患者计划进行单次或多次再手术。直肠癌合并肿瘤52例。四人转为无病状态。对故障区域进行了详细分析。单纯远处转移（DM）并不常见。腹膜种植（PS）罕见。局部失败和/或区域淋巴结转移（LF‐RF）是近50%失败组的唯一失败，92%是部分失败。如果考虑到解剖因素和肿瘤的初始病理范围，失败的模式是相当可预测的。鉴于局部区域失败的比例很高，并且能够识别此类失败风险最高的患者亚组，因此术后放疗可能是一种合理的辅助治疗。
Seventy‐five patients with complete bowel wall penetration and/or positive lymph nodes at the time of initial “curative surgery” had planned single or multiple reoperations at the University of Minnesota. Tumor due to rectal carcinoma was found in 52. Four were converted to disease‐free status. Areas of failure were analyzed in detail. Distant metastasis (DM) alone was uncommon. Peritoneal seeding (PS) was rare. Local failure and/or regional lymph node metastases (LF‐RF) occurred as the only failure in nearly 50% of the failure group and as some component in 92%. Patterns of failure are fairly predictable if anatomical factors and initial pathologic extent of tumor are considered. Postoperative irradiation may be a logical adjuvant in view of the high percentage of local‐regional failures and the ability to identify subgroups of patients at highest risk for such failure.