| 黄 飞,陈海鹏,李吉云.手术治疗46例局部复发结直肠癌的临床病理特征与生存结局分析[J].肿瘤学杂志,2021,27(8):636-642. |
| 手术治疗46例局部复发结直肠癌的临床病理特征与生存结局分析 |
| Clinicopathological Characteristics and Survival Outcomes of Surgical Treatment of Locally Recurrent Colorectal Cancer： An Analysis of 46 Patients |
| 投稿时间：2021-08-08 |
| DOI：10.11735/j.issn.1671-170X.2021.08.B006 |
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| 中文关键词: 结直肠癌 局部复发 二次手术 临床病理特征 预后 |
| 英文关键词:colorectal cancer local recurrence second operation clinicopathological characte-ristics prognosis |
| 基金项目:国家重点研发计划（2017YFC0908203）；北京市朝阳区科技计划项目（CYSF?鄄1931）；中国医学科学院医学与健康科技创新工程项目（2017?鄄I2M?鄄2?鄄003） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨手术治疗局部复发结直肠癌的临床病理特征及生存结局。［方法］ 回顾性分析2015年11月至2019年10月中国医学科学院肿瘤医院结直肠外科收治的46例局部复发结直肠癌患者资料，总结患者的临床病理特征及生存结局。［结果］ 46例局部复发患者，平均年龄（58.8±10.8）岁；其中男性31例（67.4%），女性15例（32.6%）；直肠癌患者31例（67.4%），结肠癌患者15例（32.6%）。所有患者初治均行根治性手术，病理类型均为腺癌，原发肿瘤TNM分期为Ⅲ～Ⅳ期患者17例（37.0%）。初治术前2例（4.3%）接受新辅助治疗，初治术后29例（63.0%）接受辅助治疗。最常见的局部复发部位是吻合口（31例），60.9%（28/46）的患者局部复发出现在根治术后2年内。所有患者接受二次手术治疗，40例（87.0%）进行开腹手术，5例（10.9%）行腹腔镜辅助手术，1例（2.2%）行经肛门肿物切除。二次术前9例（19.5%）患者行辅助治疗，二次术后36例（78.3%）行辅助治疗。二次手术R0切除率82.6%（38/46），术后中位住院天数7.5（2~49） d，并发症发生率为23.9%（11/46）。28例（60.9%）在二次手术后再次发生复发转移，其中1例在二次术后2个月出现腹腔多发复发转移，未进一步治疗即因多脏器衰竭死亡，其余27例患者（58.7%）接受了辅助治疗或再次手术。所有患者中位随访29（3~60）个月。R0切除患者与R1切除患者平均生存时间分别为（48.9±3.5）个月和（13.1±2.9）个月，提示R0切除较R1切除有更好的生存结局。总体2年和3年无病生存率分别为43.5%和32.7%； 2年和3年总生存率分别为76.1%和66.6%。［结论］ 对于局部复发结直肠癌患者，约60.9%的局部复发出现在根治术后2年以内，吻合口是最常见的复发部位。通过行二次手术治疗，患者可获得较好的总体生存期，但无病生存期仍较差。如何选择综合治疗，对提高局部复发患者的生存质量及预后具有重要临床意义。 |
| 英文摘要: |
| Abstract： ［Objective］ To explore the clinicopathological characteristics and survival outcomes of surgical treatment of locally recurrent colorectal cancer. ［Methods］ The clinical data of 46 patients with locally recurrent colorectal cancer admitted to the Department of Colorectal Surgery， Cancer Hospital of the Chinese Academy of Medical Sciences from November 2015 to October 2019 were analyzed. The clinicopathological characteristics and survival outcomes were described. ［Results］ Of 46 patients with local recurrence， the average age was (58.8±10.8) years； 31(67.4%) were males， 15(32.6%) were females， 31(67.4%) were rectal cancer patients， and 15(32.6%) were colon cancer patients. All patients underwent radical surgery for initial treatment. The pathological type was adenocarcinoma. The primary tumor TNM staging was 17 cases (37.0%) of stage Ⅲ~Ⅳ. 2 cases (4.3%) received neoadjuvant treatment before initial treatment， and 29 cases(63.0%) received adjuvant treatment after initial treatment. The most common local recurrence site was the anastomosis (31 cases)， and 60.9%(28/46) of the patients had local recurrence within 2 years after radical surgery. All patients underwent secondary surgery， 40 cases (87.0%) underwent open surgery， 5 cases (10.9%) underwent laparoscopic assisted surgery， and 1 case (2.2%) underwent transanal resection. 9 patients (19.5%) received adjuvant therapy before the second operation， and 36 patients (78.3%) received adjuvant therapy after the second operation. The R0 resection rate for the second operation was 82.6% (38/46)， median postoperative hospital stay was 7.5(2~49) days， and the complication rate was 23.9% (11/46). 28 patients (60.9%) had recurrence and metastasis after the second operation. One of them had multiple recurrence and metastasis in the abdominal cavity 2 months after the second operation， and died of multiple organ failure without further treatment. The remaining 27 patients (58.7%) received adjuvant treatment or reoperation. All patients were followed-up for a median of 29 (3~60) months. The average survival time of patients with R0 resection and R1 resection was(48.9±3.5) months and (13.1±2.9) months， respectively. suggesting that R0 resection had a better survival outcome than R1 resection. The overall 2-year and 3-year disease-free survival rates were 43.5% and 32.7%， respectively； the 2-year and 3-year overall survival rates were 76.1% and 66.6%， respectively. ［Conclusion］ For patients with locally recurring colorectal cancer， about 60.9% of local recurrences occurr within 2 years after radical surgery， and anastomotic recurrence is the most common site of recurrence. Through the second surgical treatment， the patients can obtain a better overall survival period， but the disease-free survival period is still poor. How to choose a comprehensive treatment has important clinical significance for improving the quality of life and prognosis of patients with local recurrence. |
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