Local excision of rectal cancer without adjuvant therapy - A word of caution
Local excision of rectal cancer without adjuvant therapy - A word of caution
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DOI：
10.1097/00000658-200003000-00007
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发表时间：
2000-03-01
影响因子：
9
通讯作者：
Rothenberger, DA
中科院分区：
文献类型：
--
作者：
Garcia-Aguilar, J;Mellgren, A;Rothenberger, DA
目的采用严格的选择标准，评价单纯局部切除治疗直肠癌的效果。背景资料多项回顾性研究表明，经过适当选择的直肠癌局部治疗患者的肿瘤控制与根治手术后的肿瘤控制情况相当。虽然对局部切除的患者选择的必要性已达成共识，但不同中心的具体标准有所不同。方法作者回顾了82例T1(n=55)和T2(n=27)直肠癌患者在10年期间仅接受经肛门切除的患者。病理检查，所有肿瘤均位于直肠壁。切缘阴性，分化好或中等。没有血管或淋巴管侵犯，也没有粘液成分。结果55例T1肿瘤患者中10例(18%)复发，27例T2肿瘤患者中10例(37%)术后54个月复发。两组患者平均复发时间均为18个月。20例局部复发的患者中有17例接受了挽救手术。T1期肿瘤生存率为98%，T2期肿瘤患者生存率为%。术前直肠超声分期不影响局部复发或肿瘤特异性生存。结论早期直肠癌局部切除，即使是最理想的，复发率也比以往报道的要高得多。虽然大多数局部复发的患者可以通过根治性切除挽救，但长期结果仍不清楚。
ObjectiveTo evaluate the results of local excision alone for the treatment of rectal cancer, applying strict selection criteria.Background DataSeveral retrospective studies have demonstrated that tumor control in properly selected patients with rectal cancer treated locally is comparable to that observed after radical surgery. Although there is a consensus regarding the need for patient selection for local excision, the specific criteria vary among centers.MethodsThe authors reviewed 82 patients with T1 (n = 55) and T2 (n = 27) rectal cancer treated with transanal excision only during a 10-year period. At pathologic examination, all tumors were localized to the rectal wall. had negative excision margins, were well or moderately differentiated. and had no blood or lymphatic Vessel invasion, nor a mucinous component. End points were local and distant tumor recurrence and patient survival.ResultsTen of the 55 patients with T1 tumors (18%) and 10 of the 27 patients with T2 tumors (37%) had recurrence at 54 months of follow-up. Average time to recurrence was 18 months in both groups. Seventeen of the 20 patients with local recurrence underwent salvage surgery. The survival rate was 98% for patients with T1 tumors and 89% for patients with T2 tumors. Preoperative staging by endorectal ultrasound did not influence local recurrence or tumor-specific survival.ConclusionLocal excision of early rectal cancer, even in the ideal candidate, is followed by a much higher recurrence rate than previously reported. Although most patients in whom local recurrence develops can be salvaged by radical resection, the long-term outcome remains unknown.