Outcomes of Surgery Alone for Lower Rectal Cancer With and Without Pelvic Sidewall Dissection
Outcomes of Surgery Alone for Lower Rectal Cancer With and Without Pelvic Sidewall Dissection
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DOI：
10.1007/dcr.0b013e3181a1d994
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发表时间：
2009-04-01
影响因子：
3.9
通讯作者：
Sugihara, Kenichi
中科院分区：
文献类型：
--
作者：
Kobayashi, Hirotoshi;Mochizuki, Hidetaka;Sugihara, Kenichi
目的：本回顾性多中心研究的目的是探讨盆腔侧壁清扫术治疗下段直肠癌的疗效。方法：回顾1991年至1998年12家机构的1272例连续接受直肠下段直肠癌全肠系膜切除术的患者的数据。比较盆腔侧壁夹层患者与非盆腔侧壁夹层患者的局部复发率和生存率。采用Logistic回归分析确定淋巴结转移和局部复发的独立危险因素，采用Cox比例风险模型确定独立预后因素。结果：1272例患者中，784例行盆腔侧壁清扫术。其中117例（14.9%）发生盆腔外侧淋巴结转移。骨盆外侧淋巴结转移的危险因素包括女性、肿瘤未分化良好的腺癌和直肠周围淋巴结转移。盆腔外侧和直肠周围淋巴结转移是局部复发的独立危险因素。Cox比例风险模型显示，年龄、组织学分级、肿瘤浸润深度、直肠周围淋巴结转移、盆腔外侧淋巴结转移是独立的预后因素。在局部复发率（10.5% vs. 7.4%）或5年总生存率（75.8% vs. 79.5%）方面，盆腔侧壁夹层患者和非盆腔侧壁夹层患者没有显著差异。尽管盆腔侧壁夹层患者的疾病晚期比例更高，但即使考虑到肿瘤类型，两组之间的局部复发率也没有差异。然而，缺乏盆腔侧壁清扫是预后不良的一个预测因素。结论：尽管盆腔侧壁剥离似乎并没有给局部复发或生存带来总体益处，但盆腔侧壁剥离在特定患者群体中的有效性仍不确定。有必要进行随机对照研究来澄清这一问题。
PURPOSE: The goal of this retrospective multicenter study was to investigate the efficacy of pelvic sidewall dissection for lower rectal cancer.METHODS: Data from 1,272 consecutive patients who underwent total mesorectal excision for lower rectal cancer in 12 institutions from 1991 through 1998 were reviewed. The rates of local recurrence and survival in patients with pelvic sidewall dissection were compared with those without pelvic sidewall dissection. Logistic regression analysis was used to determine independent risk factors for lymph node metastasis and local recurrence, and the Cox proportional hazards model was used to determine independent prognostic factors.RESULTS: Of the 1,272 patients, 784 underwent pelvic sidewall dissection. Among them, 117 patients (14.9 percent) had lateral pelvic lymph node metastasis. Risk factors for lateral pelvic lymph node metastasis included female gender, tumor not well-differentiated adenocarcinoma, and perirectal lymph node metastasis. Lateral pelvic and perirectal lymph node metastases were independent risk factors for local recurrence. The Cox proportional hazard model showed age, grade of histology, invasion depth of the tumor, perirectal lymph node metastasis, and lateral pelvic lymph node metastasis to be independent prognostic factors. No significant differences between patients with and those without pelvic sidewall dissection were seen regarding rates of local recurrence (10.5 percent vs. 7.4 percent) or five-year overall survival (75.8 percent vs. 79.5 percent). Although the proportion of patients with advanced stages of disease was greater in patients who had pelvic sidewall dissection, no differences between the two groups were seen in local recurrence even when tumor category was taken into account. However, lack of pelvic sidewall dissection was a predictor of poor prognosis.CONCLUSIONS: Although pelvic sidewall dissection does not appear to confer overall benefits regarding local recurrence or survival, the effectiveness of pelvic sidewall dissection in specific patient groups remains uncertain. A randomized controlled study is necessary to clarify this issue.