CONSERVATIVE SURGERY FOR LOW RECTAL-CARCINOMA AFTER HIGH-DOSE RADIATION - FUNCTIONAL AND ONCOLOGIC RESULTS
CONSERVATIVE SURGERY FOR LOW RECTAL-CARCINOMA AFTER HIGH-DOSE RADIATION - FUNCTIONAL AND ONCOLOGIC RESULTS
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DOI：
10.1097/00000658-199501000-00008
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发表时间：
1995-01-01
影响因子：
9
通讯作者：
PUJOL, H
中科院分区：
文献类型：
--
作者：
ROUANET, P;FABRE, JM;PUJOL, H
目的采用前瞻性、非随机研究方法，评价大剂量放疗后保守手术治疗低位直肠癌的发病率、功能和肿瘤学结果。目前保守手术的局限性是肿瘤方面的，而不是技术上的。方法自1990年6月以来，对27例直肠癌远端患者行术前放疗(40+20Gy三野放疗)和根治性手术治疗。肿瘤距肛缘平均47 mm(27~57 mm)，无1例固定(15例T2，12例T3)。保守手术21例，其中全直肠切除加结肠肛管吻合术17例，经肛门切除4例。结肠肛管吻合术后，所有患者结肠袋吻合效果良好，其中2例效果一般，1例直肠吻合效果较差。作者平均随访24个月，发现1例术后死亡，2例与疾病相关的死亡，1例可控区域复发，2例进展期肺转移患者，21例无瘤患者。结论这些初步结果证实了低位直肠癌大剂量放疗后行保守手术的可能性。可能会进行一项前瞻性的随机试验，以确定20Gy加速照射在保括约肌决定中的真正作用，
ObjectiveUsing a prospective, nonrandomized study, the authors evaluated the morbidity and functional and oncologic results of conservative surgery for cancer of the lower third of the rectum after high-dose radiation.Summary Background DataColo-anal anastomosis has made sphincter conservation for low rectal carcinoma technically feasible. The limits to conservative surgery currently are oncologic rather than technical. Adjuvant radiotherapy has proven its benefit in terms of regional control, with a dose relationship.MethodsSince June 1990, 27 patients with distal rectal adenocarcinoma were treated by preoperative radiotherapy (40 + 20 Gy delivered with three fields) and curative surgery. The mean distance from the anal verge was 47 mm (27-57 mm), and none of the tumors were fixed (15 T2, 12 T3).ResultsMortality and morbidity were not increased by high-dose preoperative radiation. Twenty-one patients underwent conservative surgery (78%-17 total proctectomies and cole-anal anastomoses, 4 trans-anal resections). After colo-anal anastomosis, all patients with colonic pouch had good results; two patients had moderate results and one patient had poor results after straight cole-anal anastomosis. With a mean follow-up of 24 months, the authors noted 1 postoperative death, 2 disease-linked deaths, 1 controlled regional recurrence, 2 evolutive patients with pulmonary metastases, and 21 disease-free patients.ConclusionsThese first results confirm the possibility of conservative surgery for low rectal carcinoma after high-dose radiation. A prospective, randomized trial could be induced to determine the real role of the 20 Gy boost on the sphincter-saving decision,