摘要
目的探究早期直肠癌非治愈性局部切除后行经肛门直肠肿物全层切除术(TAR)的安全性。方法回顾性分析2006年3月至2018年10月中国医学科学院肿瘤医院结直肠外科收治的44例局部切除直肠癌患者的临床资料,术后存在切缘阳性或可疑肿瘤残存,均接受补救性TA R手术。结果本组44例患者在局部切除术后病理报告提示切缘阳性26例,可疑肿瘤残存18例,病理类型均为腺癌,其中p T l患者41例(93%),PT 2患者3例(7%)。补救性TAR术后中位随访时间100(11~164)个月。随访期间3例(7%)发生轻度肛门失禁,1例(2%)局部复发,3例(7%)远处转移,3例(7%)非肿瘤特异性死亡。总体5年生存率和无病生存率分别为98%和93%。结论TAR应用于早期直肠癌局部切除术的补救性治疗安全可靠,患者的5年生存率与根治性手术切除相仿,并且可获得较好的肛门功能。
Objective To explore the safety of transanal re-excision(TAR)after positive-margin local resection for early rectal cancer.Methods A retrospective analysis was made data of 44 patients with rectal cancer after local excision from Mar 2006 to Oct 2018 at the Department of Colorectal Surgery,Cancer Hospital of Chinese Academy of Medical Sciences.All patients had positive margin or suspicious tumor remains after local excision,and subsequently salvage TAR surgery was performed after informed consent was given.Results Forty-four patients after local excision were with pathologically showed residual condition,including 26 cases of positive margin and 18 cases of suspicious tumor remaining.The pathological types were all adenocarcinoma.Forty-one(93%)patients with pTl and 3(7%)patients with pT2.The median follow-uptime after salvage TAR was 100(11-164)months.During follow-up,3 patients(1%)developed mild anal incontinence.One patient(2%)had local recurrence,3(7%)patients had distant metastases,and 3 patients(7%)died of non-tumor specific deaths.The overall 5-year survival rate and disease-free survival rate were 98% and 93%,respectively.Conclusions Transannal full thickness tumor re-excision is safe and reliable for the salvage treatment after non-complete local resection of early rectal cancer.The long-term follow-up results show that the 5-year survival rate is comparable to that of radical surgical resection,and with a good anal function.
作者
黄飞
卢召
程璞
张明光
陈海鹏
郑朝旭
Huang Fei;Lu Zhao;Cheng Pu;Zhang Mingguang;Chen Haipeng;Zheng Zhaoxu(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2020年第10期753-756,共4页
Chinese Journal of General Surgery
基金
国家重点研发计划(2017YFC0908203)
北京市朝阳区科技计划项目(CYSF-1931)
中国医学科学院医学与健康科技创新工程项目(2017-I2M-2-003)。
