RECURRENCE AND SURVIVAL AFTER TOTAL MESORECTAL EXCISION FOR RECTAL CANCER
RECURRENCE AND SURVIVAL AFTER TOTAL MESORECTAL EXCISION FOR RECTAL CANCER
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DOI：
10.1016/s0140-6736(86)91510-2
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发表时间：
1986-06
期刊：
影响因子：
--
通讯作者：
R. Heald;R. Ryall
中科院分区：
文献类型：
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作者：
R. Heald;R. Ryall
一个连续7年半的系列是由一家地区医院提出的政策，所有的直肠癌转介到一家外科公司。下前部切除术的表现限制了腹部会阴切除与永久结肠造口的比例为11%。在115例尝试根治性切除的患者中，69例吻合口小于5 cm， 39例壁切缘小于2.5 cm。然而，手术优先考虑的是完全切除内脏直肠肠系膜或肠系膜。术后平均4.2年，出现3例盆腔复发，但在“治愈性”手术的患者中没有发生钉线复发。校正后的5年累计生存率为87%，Dukes期无瘤生存率为A 94%， B 87%, C 58%。当采用前切除术治疗时，低肿瘤患者的治疗效果并不比高肿瘤患者差。根据这一证据，如果肠系膜癌被完整切除，限制壁间隙从而保留肛门括约肌通常是安全的。
A 7 1/2-year consecutive series is presented from a district hospital with a policy of referring all rectal carcinomas to one surgical firm. The performance of lower anterior resections has limited the rate of abdominoperineal excision with permanent colostomy to 11%. Of 115 patients in whom curative resection was attempted, 69 had anastomoses below 5 cm and 39 had mural resection margins of less than 2·5 cm. Surgical priority, however, was given to complete excision of the visceral rectal mesentery or mesorectum. At an average of 4·2 years postoperatively, three pelvic recurrences have developed but there have been no staple-line recurrences in patients who had "curative" surgery. The corrected cumulative probability of survival at 5 years is 87% and the tumour-free survival by Dukes stage is A 94%, B 87%, and C 58%. Patients with low tumours did no less well than those with high tumours, when treated by anterior resection. On this evidence, it is often safe to limit mural clearance and thus preserve the anal sphincters, provided that the mesorectum is excised intact with the cancer.