Curative potential of multimodality therapy for locally recurrent rectal cancer
Curative potential of multimodality therapy for locally recurrent rectal cancer
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DOI：
10.1097/00000658-200304000-00011
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发表时间：
2003-04-01
影响因子：
9
通讯作者：
Horgan, A
中科院分区：
文献类型：
--
作者：
Hahnloser, D;Nelson, H;Horgan, A
目的评估复发性直肠癌患者的综合治疗结果，并分析预测根治性切除和预后的总survival.Summary背景资料局部复发性直肠癌是一个困难的临床问题，根治性治疗方案与根治intention.Methods的394例患者进行了手术探查复发性直肠癌。90例发现有不可切除的局部或盆腔外疾病，304例接受了复发切除术。后者患者进行前瞻性随访，以确定长期生存和影响survival.Results的因素，总的5年生存率为25%。45%的患者获得了治愈性的阴性切缘;这些患者的5年生存率为37%，而显微镜或肉眼残留病变的患者为16%（P <0.001）。在logistic回归分析中，初次手术伴结肠造口术和症状性疼痛（均为单变量）和盆腔复发性肿瘤固定部位数量增加（多变量）与姑息性手术相关。症状性疼痛（P <0.001）和多次固定（P = 0.029）的总生存率显著降低。邻近器官扩大切除术后的生存率与有限切除术无差异（28% vs. 21%，P =. 11）。患者的人口统计学和与初始直肠癌相关的因素不影响结果。围手术期死亡率仅为0.3%，但显着的发病率发生在26%的患者，盆腔脓肿是最常见的并发症。结论这项研究表明，许多患者局部复发直肠癌可以切除阴性边缘。长期生存是可以实现的，特别是对于那些没有症状和骨盆复发固定最小的患者，只要没有明显的残留病变。
Objective To assess the results of multimodality therapy for patients with recurrent rectal cancer and to analyze factors predictive of curative resection and prognostic for overall survival.Summary Background Data Locally recurrent rectal cancer is a difficult clinical problem, and radical treatment options with curative intent are not generally accepted.Methods A total of 394 patients underwent surgical exploration for recurrent rectal cancer. Ninety were found to have unresectable local or extrapelvic disease and 304 underwent resection of the recurrence. The latter patients were prospectively followed to determine long-term survival and factors influencing survival.Results Overall 5-year survival was 25%. Curative, negative resection margins were obtained in 45% of patients; in these patients a 5-year survival of 37% was achieved, compared to 16% (P < .001) in patients with either microscopic or gross residual disease. In a logistic regression analysis, initial surgery with end-colostomy and symptomatic pain (both univariate) and increasing number of sites of the recurrent tumor fixation in the pelvis (multivariate) were associated with palliative surgery. Overall survival was significantly decreased for symptomatic pain (P < .001) and more than one fixation (P = .029). Survival following extended resection of adjacent organs was not different from limited resection (28% vs. 21%, P =. 11). Patient demographics and factors related to the initial rectal cancer did not affect outcome. Perioperative mortality was only 0.3%, but significant morbidity occurred in 26% of patients, with pelvic abscess being the most common complication.Conclusions This study demonstrates that many patients with locally recurrent rectal cancer can be resected with negative margins. Long-term survival can be achieved, especially for patients with no symptoms and minimal fixation of the recurrence in the pelvis, provided no gross residual disease remains.