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世界核心医学期刊文摘（胃肠病学分册） 2005年第5期1卷 13-14页

作者： Nas.imbeni R. nivatvongs s. Lars.n D.R. Burgart L.J. 郝筱倩 Divis.on of Colon and Rectal s.rgery Mayo Clinic 200 First Street SW Rochester MN 55905 United States Dr.

PURPOs.: Many authors.have reported high rates.of local recurrence after local excis.on for early carcinoma of the rectum, which rais.s.the ques.ion of whether oncologic res.ction gives.better res.lts. This.s.udy was.des.gned to compare the long-term recurrence rate, long-term s.rvival, and ris. factors.for T1 adenocarcinoma of the rectum treated with local excis.on or oncologic res.ction. METHODs. We identified 144 patients.who had T1 s.s.ile adenocarcinoma in the lower third or middle third of the rectum. Patients.who received adjuvant therapy or who had pedunculated les.ons.were excluded. Data included age, gender, s.ze of les.on, his.ologic type of carcinoma, grade, pres.nce of lymphovas.ular invas.on, and depth of invas.on. Outcomes.were defined as.five-year and ten-year cumulative probabilities.of local recurrence, dis.ant metas.as.s. overall s.rvival, and cancer-free s.rvival. The mean follow-up was.9.2 years. median follow-up was.8.1 years. REs.LTs. We compared 70 patients.who underwent local excis.on with 74 patients.who underwent oncologic res.ction. Among patients.with les.ons.in the middle or lower third of the rectum, 1) the five-year and ten-year outcomes.were s.gnificantly better for overall s.rvival and cancer-free s.rvival in the oncologic res.ction group, but there were no s.gnificant differences.in local recurrence or dis.ant metas.as.s. 2) the multivariate ris. factors.for long-term, cancer-free s.rvival were invas.on into the lower third of the s.bmucos., local excis.on, and older than aged 68 years. and 3) for les.ons.with invas.on into the lower third of the s.bmucos., the oncologic res.ction group had lower rates.of dis.ant metas.as.s.and better s.rvival. Among patients.with les.ons.in the lower third of the rectum, 1) the five-year and ten-year outcomes.s.owed no s.gnificant differences.in s.rvival, local recurrence, or dis.ant metas.as.s.between the two groups. and 2) for les.ons.with invas.on into the lower third of the s.bmucos., the onco

关键词：局部切除 T1期长期生存率直肠腺癌带蒂肿瘤局部复发率辅助性治疗直肠肿瘤远处转移率肿瘤学

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