Pelvic resection of recurrent rectal cancer - Technical considerations and outcomes
Pelvic resection of recurrent rectal cancer - Technical considerations and outcomes
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DOI：
10.1007/bf02235044
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发表时间：
1999-11-01
影响因子：
3.9
通讯作者：
Wrobleski, DE
中科院分区：
文献类型：
--
作者：
Wanebo, HJ;Antoniuk, P;Wrobleski, DE
目的：直肠癌盆腔复发对患者来说是一个不祥的事件，对主治外科医生来说是一个巨大的挑战。我们回顾了腹骶切除术的结果，以管理这些患者，并将结果（生存和复发）与已知的预后因素相关。方法：对 61 例盆腔复发患者进行腹骶切除术（其中 53 例为根治性手术，6 例为姑息治疗；2 例为扩大盆腔切除术）。 53例患者（男性32例，平均年龄53岁）中，既往接受腹会阴切除术27例，腹会阴切除加肝叶切除术2例，低位前切除术19例，三节段切除术1例，晚期原发癌4例，初始分期为Dukes B（64%）和Dukes C（36%）。所有患者均已接受过照射（50 名患者接受了 3,000-6,500 次照射，2 名患者接受了 8,300 次和 11,000 次照射，3 名患者接受了未知剂量）。术前癌胚抗原升高（>5 ng/ml）的比例为 54%。切除范围：高位骶骨切除S-1-S2 32例，骶中段14例，低位S4-S-5 6例。 28 名患者 (60%) 需要部分或完全切除膀胱，包括或不包括邻近内脏，并且所有患者均进行了髂内和闭孔淋巴结切除术。结果：术后（60 天内）有 4 例死亡，治疗组死亡率为 8%（总体为 5.4%）。主要并发症包括插管时间延长（20%）、败血症（34%）、后伤口感染或皮瓣分离（38%）。治疗组（19名术后幸存者）的存活率为31%，其中13名患者存活超过五年。其中7名患者存活了5至21年，而6名患者在腹骶切除术后5.5至7.5年内再次复发并死亡。五年无病生存率为 23%。最近对 5 名患者进行了大型复合肌皮瓣重建，使骶骨伤口完全覆盖，从而可以更早下床活动并减少住院时间。结论：腹骶切除术可以切除固定于骶骨的直肠癌盆腔复发，并且与 32% 的患者的长期生存相关。最近的技术进步改善了短期结果，并使熟悉这些技术的手术团队更加可行。
PURPOSE: Pelvic recurrence of rectal cancer is an ominous event for the patient and a formidable challenge to the managing surgeon. We reviewed the results of abdomino-sacral resection to manage these patients and correlated outcome (survival and recurrence) with known prognostic factors. METHODS: An abdominosacral resection was performed on 61 patients with pelvic recurrence (53 with curative intent and 6 for palliation; 2 had extended pelvic resection). Of the 53 patients (32 males; average age, 53 years) previous resection included abdominoperineal resection in 27 patients, abdominoperineal resection plus hepatic lobectomy in 2 patients, low anterior resection in 19 patients, plus trisegmentectomy in I patient, and advanced primary cancers in 4 patients, initial primary stage was Dukes B (64 percent) and Dukes C (36 percent). AU had been irradiated (3,000-6,500 in 50 patients, 8,300 and 11,000 in 2 patients, and unknown dose in 3 patients). Preoperative carcinoembryonic antigen was elevated (>5 ng/ml) in 54 percent. Extent of resection: high sacral resection S-1-S2 was done in 32 patients, midsacrum in 14 patients, and low S4-S-5 in 6 patients. Twenty-eight patients (60 percent) required partial or complete bladder resection with or without adjacent viscera, and all had internal iliac and obturator node dissection. RESULTS: There were four postoperative (within 60 days) deaths, 8 percent in curative groups (5.4 percent overall). Major complications included prolonged intubation (20 percent), sepsis (34 percent), posterior wound infection or flap separation (38 percent). The survival rate in the curative group C 19 postoperative survivors) was 31 percent at live years, with 13 patients surviving beyond five years. Seven of these patients survived from 5 to 21 years, whereas six patients recurred again and died within 5.5 to 7.5 years after abdominosacral resection. Disease-free survival rate at five years was 23 percent. Recent reconstruction with large composite myocutaneous gluteal flaps in 5 patients permitted complete sacral wound coverage, resulting in earlier ambulation and reduced hospital stay. CONCLUSIONS: Abdominosacral resection permits removal of pelvic recurrence of rectal cancer that is fixed to the sacrum and is associated with long-term survival in 32 percent of patients. Recent technical advances have improved the short-term outcome and have made the procedure more feasible for surgical teams familiar with these techniques.