低位直肠癌局部切除术后复发因素分析

目的探讨低位直肠癌局部切除术后复发的相关因素。方法回顾分析1975年4月至2005年4月间收治的97例早期低位直肠癌行局部切除治疗患者的临床资料。结果全组Tis、T1和T2期病变者分别为28例、48例和21例；有17例（17．5％）患者出现复发，其中局部复发13例．局部复发伴远处转移2例．局部复发率15．5％；Tis、T1和T2期病变者局部复发率分别为7．1％、12．5％和33．3％：另有2例远处转移。局部切除术后复发时问为4～173（中位时间27）个月。肿瘤大体类型和T分期为局部切除术后局部复发的相关因素（P〈0．05）。T2期病变者局部切除术后行和未行辅助治疗的局部复发率分别为21．4％和57．1％（P=0．127）。带蒂肿瘤、无蒂肿瘤和溃疡型肿瘤的局部复发率分别为10．5％、13．7％和3／5。15例局部复发者经治疗后的5年生存率为59．6％。结论低位直肠癌局部切除术后T分期和肿瘤的大体类型是局部复发的主要因素，T2期病变局部切除后需行辅助治疗或行根治性切除术。

Analysis of factors related to recurrence after local excision for low rectal cancer

Objective To discuss the factors predicting recurrence after local excision for low rectal cancer. Method Medical records and follow-up histories of 97 patients undergone local excision of adenocarcinoma of the rectum between april, 1975 and april, 2005 in Cancer Hospital of the Chinese Academy of Medical Sciences were reviewed retrospectively.Results Postoperative pathologic examination revealed 28 pTis cases, 48 pT1 cases, and 21 pT2 cases. Eighty-nine patients underwent transanal excision, 7 transsacral excision, and 1 transvaginal excision. Twenty-two (45.8%) patients with T1tumors and 14 (66.7%) patients with T2 tumors were treated with postoperative radiotherapy with or without 5-fluorouracil. Seventeen (17.5%) patients presented recurrence,including 13 local recurrence, 2 local and distant recurrence, and 2 distant recurrence. The local recurrence rate was 15.5%. Median time to relapse was 27 months (range 4-73). The incidence of local recurrence were 7.1%, 12.5%, and 33.3% for patients with pTis, pT1, and pT2 (P=0.031) respectively. The local recurrence rate was 10.5%, 13.7%, and 3/5 for patients with pedunculated, sessile, and ulcerative carcinoma(P=0.017). The local recurrence of patients with T2 tumors treated via local excision with or without chemoradiotherapy was 21.4%(3/14) and 4/7, but the difference was no significance(P=0.127). All the 15 patients with local recurrence underwent salvage resection, and the 5-year survival rate after salvage surgery was 59.6%. Conclusions Higher rates of recurrence are seen in patients with T2 tumors and ulcerative carcinoma. Chemoradiotherapy or radical surgery should be chosen for T2 tumors following local excision. Salvage resection should be considered after local recurrence.