Differences between proximal and distal obstructing colonic cancer after curative surgery
Differences between proximal and distal obstructing colonic cancer after curative surgery
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DOI：
10.1111/j.1463-1318.2010.02549.x
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发表时间：
2011-06-01
影响因子：
3.4
通讯作者：
Jaurrieta, E.
中科院分区：
文献类型：
--
作者：
Frago, R.;Biondo, S.;Jaurrieta, E.
目的探讨梗阻性结肠癌根治术后不同部位的发病率、病死率及总生存率的差异。根据肿瘤相对于脾弯曲的位置，这两组被定义为近端和远端。在外科医生专科方面，患者由结直肠外科医生和普通外科医生进行手术。结果377例患者中近端组173例(45.9%)，远端组204例(54.1%)。总发生率为54.9%，除吻合口漏外，其余两组术后并发症发生率无差异(P<；0.014)。两组术后死亡率无明显差异。在按肿瘤转移系统对患者进行分层后，两组在3年总生存期、癌症相关生存期和无复发概率方面的差异无统计学意义。结肠癌根治性手术后总存活率为57.6%。结论结肠癌急诊手术后死亡率和发病率较高。结直肠外科的专业化会降低急诊近端结肠切除术后吻合口裂开的发生率，从而影响术后效果。根治性手术后，肿瘤部位似乎不会影响梗阻性结肠癌的预后。
AimTo study any possible differences in morbidity, mortality and overall survival rate after curative surgery for obstructive colon cancer according to tumour location.MethodFrom January 1994 to December 2006, patients with colonic cancer presenting as obstruction were analysed. The two groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. In relation to the surgeon specialization, patients were operated on by a colorectal surgeon and by a general surgeon. Postoperative morbidity and mortality and cancer-related survival at 3 years were analysed.ResultsOf the 377 patients included in the study, there were 173 patients (45.9%) in the proximal group and 204 patients (54.1%) in the distal group. The global morbidity was 54.9% without differences in postoperative morbidity except for anastomotic leakage, which was higher in the proximal group (P < 0.014). No differences in postoperative mortality were observed. After patients were stratified by the tumour node metastasis system, the differences between the groups, with respect to 3-year overall survival, cancer-related survival and probability of being free from recurrence, did not reach statistical significance. The overall survival after radical surgery for colonic obstruction was 57.6%.ConclusionMortality and morbidity after emergency surgery for obstructing colon cancer are high. Specialization in colorectal surgery influences postoperative results in terms of lower anastomotic dehiscence rate after emergency proximal colon resection. After radical surgery, tumour location does not appear to influence the prognosis of obstructive colon cancer.