Transanal excision vs. major surgery for T1 rectal cancer
Transanal excision vs. major surgery for T1 rectal cancer
复制标题
DOI：
10.1007/s10350-005-0044-6
复制
发表时间：
2005-07-01
影响因子：
3.9
通讯作者：
Wibe, A
中科院分区：
文献类型：
--
作者：
Endreseth, BH;Myrvold, HE;Wibe, A
目得：这项全国性研究的目的是检查T1直肠癌经肛门切除术与大手术的长期结果。方法：这项来自挪威直肠癌项目的前瞻性研究纳入了1993年11月至1999年12月期间接受前切除术、腹会阴切除术、Hartmann手术或经肛门切除术治疗的所有291例距肛缘15 cm以内的T1MO肿瘤患者。结果：200例五十六例患者接受了大手术治疗，35例患者接受了经肛门切除术。无患者接受新辅助治疗。17%（6/35）的经肛门切除术中出现肉眼可见的肿瘤残留（R2），而大手术获得了100%的R0切除。11%的接受大手术治疗的患者有腺体受累。根据肿瘤定位、大小或分化，I期和III期肿瘤之间无显著差异。经肛门切除术患者的年龄大于大手术患者（平均年龄77岁对68岁，P <0.001）。根治性切除术（R0，R1，Rx）后，经肛门切除组的5年局部复发率为12%（95%置信区间，0 - 24），而大手术后为6%（95%置信区间，2 - 10）（P = 0.010）。总体五年生存率为70%（95%置信区间，52 - 88），经肛门切除组为80%，（95%置信区间，74 - 85）（P = 0.04），5年无病生存率为64（95%置信区间，46 - 82）经肛门切除组与77%（95%置信区间，71 - 83）在大手术组（P = 0.01）。结论：目前研究中经肛门切除早期直肠癌的主要问题是不能切除所有的恶性肿瘤。经肛门切除术的患者与接受大手术的患者相比，局部复发率明显较高。经肛门切除的患者生存率较低，但他们比那些大手术的患者年龄大。
PURPOSE: The purpose of this national study was to examine the long-term results of transanal excision compared with major surgery of T1 rectal cancer. METHODS: This prospective study from the Norwegian Rectal Cancer Project included all 291 patients with a T1MO tumor within 15 cm from the anal verge treated by anterior resection, abdominoperineal resection, Hartmann's procedure, or transanal excision in the period from November 1993 to December 1999. RESULTS: Two hundred fifty-six patients were treated by major surgery and 35 patients by transanal excision. None of the patients had neoadjuvant therapy. Macroscopic tumor remnants (R2) occurred in 17 percent (6/35) of the transanal excisions, while major surgery obtained 100 percent R0 resections. Eleven percent of the patients treated with major surgery had glandular involvement. There were no significant differences according to tumor localization, size, or differentiation between Stage I and Stage III tumors. Patients treated with transanal excision were older than patients having major surgery (mean age, 77 vs. 68 years, P < 0.001). After curative resection (R0, R1, Rx) the five-year rate of local recurrence was 12 percent (95 percent confidence interval, 0-24) in the transanal excision group compared with 6 percent (95 percent confidence interval, 2-10) after major surgery (P = 0.010). The overall five-year survival was 70 percent (95 percent confidence interval, 52-88) in the transanal excision group compared with 80 percent (95 percent confidence interval, 74-85) in the major surgery group (P = 0.04) and the five-year disease-free survival was 64 percent (95 percent confidence interval, 46-82) in the transanal excision group compared with 77 percent (95 percent confidence interval, 71-83) in the major surgery group (P = 0.01). CONCLUSIONS: The main problem of transanal excision for early rectal cancer in the present study was the inability to remove all the malignancy. Patients treated with transanal excision had significantly higher rates of local recurrence compared with patients who underwent major surgery. Patients who had transanal excision had inferior survival, but they were older than those who had major surgery.