T1 adenocarcinoma of the rectum - Transanal excision or radical surgery?
T1 adenocarcinoma of the rectum - Transanal excision or radical surgery?
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DOI：
10.1097/01.sla.0000183355.94322.db
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发表时间：
2005-10-01
影响因子：
9
通讯作者：
Paty, PB
中科院分区：
文献类型：
--
作者：
Bentrem, DJ;Okabe, S;Paty, PB
背景资料：最近的研究表明，局部切除可能是T1直肠腺癌的可接受的治疗方法，但很少有与根治性手术的比较数据来评估结果和量化风险。我们对在我们机构接受经肛门切除术或根治性切除术治疗的T I期直肠癌患者进行了回顾性评价，以评估患者选择、癌症复发和生存率。所有接受T1直肠腺癌手术的患者从前瞻性数据库中识别1987年1月至2004年1月期间通过经肛门切除术（TAE）或根治性切除术（RAD）治疗的直肠癌（距肛缘0-15 cm）。数据进行分析，使用Fisher精确检验，Kaplan-Meier法，和log-rank test.Results：319例T1病变连续治疗经肛门切除术（n = 151）或根治性手术（n = 168）在17年的时间。RAD手术与直肠中较高的肿瘤位置、稍大的肿瘤大小、相似的不良组织学发生率和18%的淋巴结转移率相关。尽管有这些特征，接受RAD手术的患者局部复发较少，远端复发较少，无复发生存率显著提高（P = 0.0001）。RAD和TAE groups.Conclusion的总体和疾病特异性生存率相似：尽管在2个手术组的风险特征相似，T1直肠癌局部切除治疗的患者观察到有3- 5倍的肿瘤复发的风险比根治性手术治疗的患者。局部切除术应保留给低风险癌症患者，这些患者将接受肿瘤复发风险增加，长期监测和可能需要积极的挽救手术。根治性切除术是T1直肠癌更确定的手术治疗。
Background: Recent studies suggest local excision may be acceptable treatment of T 1 adenocarcinoma of the rectum, but there is little comparative data with radical surgery to assess outcomes and quantify risk. We performed a retrospective evaluation of patients with T I rectal cancers treated by either transanal excision or radical resection at our institution to assess patient selection, cancer recurrence, and survival.Methods: All patients who underwent surgery for T1 adenocarcinomas of the rectum (0-15 cm from anal verge) by either transanal excision (TAE) or radical resection (RAD) between January 1987 and January 2004 were identified from a prospective database. Data were analyzed using Fisher exact test, Kaplan-Meier method, and log-rank test.Results: Three hundred nineteen consecutive patients with T1 lesions were treated by transanal excision (n = 151) or radical surgery (n = 168) over the 17-year period. RAD surgery was associated with higher tumor location in the rectum, slightly larger tumor size, a similar rate of adverse histology, and a lymph node metastasis rate of 18%. Despite these features, patients who underwent RAD surgery had fewer local recurrences, fewer distant recurrences, and significantly better recurrence-free survival (P = 0.0001). Overall and disease-specific survival was similar for RAD and TAE groups.Conclusion: Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of T1 rectal cancers.