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目的探讨局部进展期原发和复发直肠癌(locallyadvancedrectalcancer,LARC)行全盆腔脏器切除术(totalpelvicexenteration,TPE)的疗效。方法对1989￣2003年行TPE的28例原发癌和35例复发癌进行回顾性分析。结果全组根治性切除率85.7%,其中原发癌组92.9%,复发癌组80.0%。术后病理证实原发癌组盆腔脏器/组织受侵率67.9%,复发癌组盆腔脏器/组织受侵率100%。原发癌组仅14.3%侵犯盆壁组织;而复发癌组80.0%侵犯达盆壁组织。原发癌组、复发癌组手术死亡率分别为0、2.9%,术后并发症率分别为32.1%、51.4%。全组术后复发率68.4%、原发癌组61.5%、复发癌组72.0%。复发癌组盆腔局部复发率48.0%,高于原发癌组的15.4%(P<0.05)。全组术后5年生存率23.7%,原发癌组、复发癌组分别为38.5%、16.0%(P>0.05)。结论TPE是治疗LARC的有效方法,尽可能行根治性切除是改善LARC尤其是复发癌预后的关键。
Objective To investigate the curative effect of total pelvic organ excision (TPE) in locally advanced primary and recurrent rectal cancer (LARC). Methods A retrospective analysis was performed on 28 primary and 35 recurrent cancer patients who underwent TPE between 1989 and 2003. Results The radical resection rate of the whole group was 85.7%, of which 92.9% in the primary cancer group and 80.0% in the recurrent cancer group. Postoperative pathology confirmed pelvic organ / tissue invasion rate of primary cancer group 67.9%, pelvic organ / tissue invasion rate of recurrence cancer group 100%. Only 14.3% of primary cancers invaded the pelvic tissues, while 80.0% of the recurrent cancers invaded the pelvic tissues. The operative mortality of primary cancer group and recurrent cancer group were 0 and 2.9% respectively, and the postoperative complication rates were 32.1% and 51.4% respectively. The recurrence rate was 68.4% in the whole group, 61.5% in the primary cancer group and 72.0% in the recurrent cancer group. The pelvic recurrence rate was 48.0% in recurrent cancer group, which was higher than that in primary cancer group (15.4%, P <0.05). The 5-year survival rate was 23.7% in the whole group, 38.5% and 16.0% in the primary cancer group and the recurrent cancer group (P> 0.05). Conclusion TPE is an effective method for the treatment of LARC. Radical resection as much as possible is the key to improve the prognosis of LARC, especially recurrent carcinoma.