食管癌患者术后肿瘤复发和转移的危险因素分析

目的探讨影响食管癌患者术后导致肿瘤复发、转移的危险因素,为临床制定术后治疗方案提供依据。方法对2002年1月至2005年1月在甘肃省肿瘤医院行食管癌手术切除的出院患者533例进行随访。纳入随访资料完整、术后生存5年以上并无确切复发、转移的124例患者作为长期生存组,其中男105例,女19例;平均年龄64岁。术后1年内由于肿瘤复发、转移而死亡的62例患者作为短期生存组,其中男56例,女6例;平均年龄62岁。采用单因素分析筛选肿瘤复发、转移的潜在危险因素,进行logistic回归多因素分析筛选危险因素,应用Spearman相关分析法进行相关分析。结果单因素分析结果显示,两组肿瘤长度（x2=13．459,P=0．001）、肿瘤根治程度（x2=42．470,P=0．000）、肿瘤分化程度（x2=11．010,P=0．004）、肿瘤浸润深度（x2=66．577,P=0．000）、残端情况（x2=42．740,P=0．000）、有无淋巴结转移（x2=60．043,P=0．000）以及淋巴结转移数（x2=72．901,P=0．000）差异均有统计学意义。多因素分析显示肿瘤分化程度EOR=2．444,95％CI（L205,4．957）,P=0．013]、肿瘤浸润深度[0R=6．145,95％CI（3．022,12．495）,P=0．000]、有无淋巴结转移[OR=12．151,95％CI（4．961,29．763）,P=0．000]、淋巴结转移数EOR：11．935,95％CI（3．492,23．541）,P=0．000]和残端情况EoR=13．081,95％CI（2．043,83．775）,P=0．007]与食管癌患者预后明显相关。相关分析发现肿瘤浸润深度与有无淋巴结转移呈正相关（r=0．496,P〈0．001）,肿瘤浸润深度与有淋巴结转移数呈正相关（r=0．519,P〈o．001）。结论肿瘤分化程度、肿瘤浸润深度、淋巴结转移和残端情况是影响食管癌患者复发、转移和生存时间的关键因素。目前食管癌TNM分期未能完全反映对预后的影响和指导制定术后综合治疗方案,应从多方位分析相关恶性度生物学行为。     

胸上段食管癌临床病理与预后分析

目的探讨胸上段食管癌的临床病理特征及其与预后的关系。方法回顾性分析1996年1月至2001年12月65例胸上段食管癌患者的临床病理特征及其预后影响因素。结果患者1、3、5年生存率分别为72.3％、36．9％、21．5％。单因素分析显示患者预后与肿瘤浸润深度、肿瘤大小、临床分期、淋巴结转移、肿瘤根治程度等因素有关（P〈0．05）；多因素分析显示，肿瘤根治程度、淋巴结转移、肿瘤浸润深度为影响食管癌切除术后预后的重要因素（P〈0．05）。结论肿瘤根治程度、淋巴结转移、肿瘤浸润深度是影响预后的独立因素。     

进展期胃癌D2根治术中第14v组淋巴结清扫的意义

目的探讨进展期胃癌行D：根治术时第14v组淋巴结清扫的必要性。方法回顾性分析2003至2007年间天津医科大学附属肿瘤医院收治的131例行胃癌根治术（D2或D2＋）并同时加行第14v组淋巴结清扫的胃癌患者的临床病理资料,分析影响第14v组淋巴结转移的临床病理因素以及第14v组淋巴结转移与预后的关系。结果131例患者中24例（18．3％）有第14v组淋巴结转移。原发灶部位、肿瘤大小、浸润深度、淋巴结分期、TNM分期、第1、6、8a组淋巴结转移与第14v组淋巴结转移有关（均P〈0．05）;其中原发灶部位和淋巴结分期是影响第14v组淋巴结转移的独立因素（均P〈0．05）。第14v组淋巴结转移和未转移患者5年生存率分别为8．3％和37．8％,差异有统计学意义（P〈0．01）。多因素预后分析证实。第14v组淋巴结转移是影响进展期胃癌D：根治术后生存的独立危险因素（P=-0．029,RR=1．807,95％CI：1．064-3．070）。结论对于进展期胃中下部癌．尤其是肿瘤体积较大、浆膜受侵犯、第6组淋巴结可疑转移的患者,第14v组淋巴结清扫是必要可行的。     

应用Cox模型分析影响胆管癌切除术后的预后因素

目的：探讨影响胆管癌切除术后的预后因素。方法：对1980－1995年86例胆管癌切除术后患者进行研究。选择15个可能对胆管癌切除术后预后产生影响的非重复性特征临床因素，通过Cox比例风险模型对胆管癌切除术后患者预后进行多因素分析。结果；全组1年生存率为72．6％，3年生存率为32．4％，5年生存为18．7％。单因素分析得出肿瘤的组织学类型，淋巴结转移，胰腺浸润，十二指肠浸润，神经浸润，周围血管浸润，切缘癌残留和浸润深度对预后有影响（P＜0．05）。Cox模型多因素分析结果表明，胰腺浸润，神经浸润和淋巴结转移是影响预后的主要因素。结论：胰腺浸润，神经浸润和淋巴结转移状况是胆管癌切除术后影响预后的最重要因素。     

217例胃肠间质瘤临床分析

目的探讨胃肠间质瘤（GIST）的临床特征、诊治及影响预后的因素。方法回顾性分析2005年1月至2010年9月华中科技大学同济医学院附属协和医院经手术治疗的217例GIST患者的临床病理资料。比较不同因素对患者预后的影响。结果217例患者中男性103例,女性114例,中位年龄55岁。除4例患者因广泛浸润未完整切除外,其余213例均行完整切除,其中35例行腹腔镜手术;48例术后EI服伊马替尼。178例（82．0％）患者获得术后随访,随访时间3。74个月。随访期间有16例（9．0％）发生术后复发和（或）转移,Logistic回归分析显示．肿瘤部位（OR=2．547,95％CI：1．466～4．424）和核分裂像（OR=6．556,95％CI：2．974。14．449）是影响根治术后复发和（或）转移的独立危险因素。随访患者中带瘤生存者5例,11例死于GIST,其中小肠GIST7例,肠道外GIST4例。Cox回归分析显示,核分裂像（RR=2．654,95％CI：1．094～6．438）与复发和（或）转移（RR=32．988,95％CI：3．879～280．529）是GIST患者的独立预后因素。结论肿瘤部位与核分裂像是影响GIST根治术后复发和（或）转移的独立因素,核分裂像与术后复发和（或）转移是影响GIST预后的独立因素。外科手术完整切除联合靶向治疗可使GIST患者获得满意疗效。     

淋巴结转移阴性的低分化和未分化胃腺癌的预后因素分析

目的 探讨影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素.方法 回顾性分析2002年1月至2007年12月天津医科大学附属肿瘤医院收治的270例淋巴结转移阴性的低分化和未分化胃腺癌患者的临床病理资料.患者均行胃癌根治术,其中术中淋巴结清扫数目＜15枚的患者161例、15～20枚患者53例、21 ～30枚患者33例、＞30枚患者23例.采用门诊、电话、信件等方式进行随访.随访时间截至2013年10月.采用COX模型逐步后退法进行预后因素分析.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 270例患者术后均获得随访,随访率为100.00％（270/270）,中位随访时间为63个月（2～103个月）.患者总体中位生存时间为63个月（2～103个月）,1、3、5年总体生存率分别为93.0％ 、69.5％ 、58.5％.其中161例淋巴结清扫数目＜15枚患者中位生存时间为58个月（2～103个月）,1、3、5年生存率分别为91.4％、59.3％、48.8％;53例淋巴结清扫数目15 ～ 20枚患者中位生存时间为68个月（4 ～95个月）,1、3、5年生存率分别为94.3％、84.9％、71.7％;33例淋巴结清扫数目21～ 30枚患者中位生存时间为68个月（34 ～ 94个月）,1、3、5年生存率分别为100.0％、97.0％、87.9％;23例淋巴结清扫数目＞30枚患者中位生存时间为60个月（2～84个月）,1、3、5年生存率分别为87.5％、62.5％、54.2％.不同淋巴结清扫数目患者预后比较,差异有统计学意义（x2=25.077,P＜0.05）.淋巴结清扫数目21 ～30枚患者预后优于15 ～20枚患者,差异有统计学意义（x2=3.924,P＜0.05）;淋巴结清扫数目15 ～ 20枚患者预后优于＞30枚患者,差异有统计学意义（x2=4.454,P＜0.05）;淋巴结清扫数日＞30枚患者与＜15枚患者预后比较,差异无统计学意义（x2=0.450,P＞0.05）.单因素分析结果显示：患者性别、年龄、肿瘤部位、肿瘤直径、浆膜浸润、Borrma     

孤立性淋巴结转移对胃癌预后的影响

目的探讨胃癌发生孤立性淋巴结转移对患者预后的影响。方法总结1995年1月至2003年12月间施行胃癌D2根治术的280例患者的临床资料．比较分析有淋巴结孤立性转移（孤立转移组）与无淋巴结转移（无转移组）两组患者的预后差异,进一步比较孤立转移组中跳跃性与非跳跃性淋巴结转移患者预后的差异：并进行预后因素分析。结果孤立转移组患者83例．无转移组患者197例。孤立转移组和无转移组术后5年生存率分别为623％和83．5％．差异有统计学意义（P〈0．05）。孤立性淋巴结转移是影响本组患者预后的独立因素之一（P〈0．01）。肿瘤浸润深度是胃癌孤立性淋巴结转移的独立危险因素（P〈0．05）。孤立转移组中跳跃性淋巴结转移者19例（22．9％）,跳跃性与非跳跃性淋巴结转移患者术后5年生存率分别为50．0％和66．1％．差异无统计学意义（P〉0．05）。结论发生孤立性淋巴结转移的胃癌患者预后较无淋巴结转移者差。施行D2根治术有助于跳跃性淋巴结转移的清扫．     

应用Cox模型分析影响胸段食管癌切除术预后的因素

目的 分析影响胸段食管癌切除术后患者预知的因素,探讨各因素之间的关系。方法 采用计算机比例风险模型（Cox模型）,对影响胸段食管癌三区域淋巴结清除根治术患者预后的临床因素进行分析。结果 预后与肿瘤侵及深度、分化程度、临床分期、淋巴结转移个数及区域数呈正相关,而与年龄呈负相关（P＜0．01）;性别和肿瘤长度与预后无关。淋巴结转移个数与肿瘤分化程度和侵及深度呈正相关,与年龄呈负相关（P＜0．01）,而与3年和5年生存率显著相关（P＜0．01）。本组5年生存率为53．7％。结论 胸段食管癌的预后与肿瘤的侵及深度、分化程度、淋巴结转移个数、肿瘤的部位及患者年龄等因素密切相关;胸段食管癌三区域淋巴结清除根治术有效地提高了淋巴结转移阴性和转移较少患者的生存率。     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

目的 探讨影响T1～2期结直肠癌淋巴结转移及预后的因素,为临床治疗提供参考.方法 回顾性分析上海第二军医大学附属长海医院1999年1月至2005年1月行结直肠癌根治手术并经病理证实为T1～2期的132例患者的临床资料.结果 肿瘤部位和肿瘤浸润深度是影响本组T1～2期结直肠癌患者淋巴结转移的独立危险因素（分别为P＜0.01和P＜0.05）;而患者性别、年龄、肿瘤大体类型、肿瘤组织学类型、肿瘤分化程度、CEA水平、肿瘤直径均与其淋巴结转移无关（均P＞0.05）.淋巴结转移和术后随访过程中远处脏器的转移是影响患者生存的独立危险因素（分别为P＜0.05和P＜0.01）.结论 影响T1～2期结直肠癌患者淋巴结转移的因素并不影响患者的生存,但淋巴结转移和远处脏器转移是影响预后的危险因素     

结肠癌根治术后转移复发的特点及预后分析

目的 探讨结肠癌根治术后肿瘤转移复发的特点和影响预后的因素。方法回顾性分析310例结肠癌患者根治术后转移复发的特点，并对预后进行单因素及多因素分析。结果本组患者结肠癌行根治术后转移复发率为23．2％（72例），其中3年内转移复发者占76．4％（55例）。肝转移28例（38．9％），多脏器转移16例（22．2％）。X^2检验显示，肿瘤大体类型、分化程度、有无淋巴结转移、Stage分期与转移复发相关。本组5年生存率64．6％。单因素分析显示，肿瘤大体类型、组织学类型、分化程度、淋巴结转移、脉管瘤栓、Stage分期、有无化疗和门脉化疗与预后相关；多因素分析显示，肿瘤大体类型、淋巴结转移、术后有无化疗和门脉化疗为影响预后最重要的因素。结论结肠癌患者根治术后转移复发多在3年内，肝脏是最常见的转移部位。肿瘤大体类型、淋巴结转移、有无化疗和门脉化疗是结肠癌术后影响预后的重要因素。     

胃底贲门癌根治术中保留脾脏对预后的影响

目的探讨胃底贲门癌根治术中保留脾脏对预后的影响。方法回顾性分析1994年7月至2003年12月间108例经根治性手术治疗的胃底贲门癌患者的临床病理资料,比较保脾与切脾两组患者的并发症发生情况和预后。结果切脾组38例,保脾组70例,最后随访日期2004年12月。本组淋巴结转移率68.5%(74/108),第10组淋巴结转移率16.7%。切脾组与保脾组术后并发症发生率(18.4%vs14%,χ2=0.318,P=0.573)、肿瘤复发率和肿瘤病理特征差异均无统计学意义。保脾组5年生存率明显高于切脾组(38.7%vs16.9%,P=0.008)。多因素分析显示,保留脾脏不是影响预后的独立因素(P=0.085),只有肿瘤浸润程度(P=0.009)和淋巴结转移(P=0.001)是独立的预后因素。结论除脾脏受侵犯者外,贲门癌根治术中应尽可能保留脾脏。     

Spleen Preservation in Radical Surgery for Gastric Cardia Cancer

Background In gastric cardia cancer (GCC), the spleen is usually removed when the tumor is resected. This allows thorough lymph node dissection in the splenic hilus. However, the long-term effect of splenectomy on patient survival is controversial. The purpose of this study was to investigate the effect of spleen preservation on survival following radical resection for gastric cardia cancer. Methods We reviewed the records of 116 GCC patients (Siewert types II and III) who underwent radical resection with D2 or D3 lymphadenectomy between July 1994 and December 2003. Survival status was ascertained in December 2004 and data from 108 patients were analysed. Of these 108 patients, 38 underwent splenectomy and 70 had splenic preservation. Clinicopathological features and prognostic data of the splenectomy(+) and splenectomy(−) groups were compared. Results Seventy-four patients (68.5%) had lymph node involvement; 18 (16.7%) had involvement of nodes in the splenic hilus. Postoperative morbidity in the two groups was similar. Overall 5-year survival was higher in the splenectomy(−) group than the splenectomy(+) group (38.7% versus 16.9%, P =.008). Multivariate regression indicated that tumor invasion (P =.009) and lymph node metastasis (P = .001) were independent prognostic factors – they predicted decreased survival – with or without splenectomy. Although splenectomy was be associated with lower survival, it was not an independent prognostic factor (P =.085). Conclusions Splenectomy does not improve survival of patients who undergo curative resection for gastric cardia cancer. Thus, the spleen should be preserved in patients without direct cancer invasion of the spleen. Supported by the Project of 211 from Chinese Education Ministry, No.98087.     

Results of surgical treatment of adenocarcinoma of the gastric cardia

BACKGROUND: Comparison among different studies regarding adenocarcinoma of the cardia has been difficult since the Siewert classification was introduced. This study analyzed the experience of a single institution in the treatment of gastric cardia cancer with the aim of assessing principal prognostic factors and long-term outcome. METHODS: The results of 96 patients who underwent resection with curative intent for gastric cardia cancer at the First Division of General Surgery, University of Verona, from January 1988 to February 2000, were analyzed statistically with special reference to Siewert type. RESULTS: Despite a high number of curative resections (85.4%), the 5-year survival rate was poor (24%) for all Siewert types (p = 0.8), and for early tumors (51%) also. Chance of cure was limited to pN0 and pN1 patients. Multivariate analysis showed that microscopic or macroscopic residual tumor and pN-positive categories had a significantly higher risk of death (risk ratio, 2.18 and 2.68, respectively) and the pN2 and pN3 category had the most negative prognostic factor (risk ratio, 7.6). CONCLUSIONS: The long-term prognosis for gastric cardia cancer remains poor and is independent of Siewert type, with cure limited to pN0 and pN1 patients.     

Clinicopathological characteristics and prognosis of carcinoma of the gastric cardia

OBJECTIVE: The prognosis of patients with carcinoma of the gastric cardia (CGC) is poorer than that of patients with distal third gastric carcinoma (DTGC). The main aim of this study is to investigate whether the tumor location is an important prognostic factor. METHODS: 312 patients (8.1%) were diagnosed with CGC and reviewed retrospectively. RESULTS: T1 stage tumors were less common in patients with CGC than in those with DTGC (p< 0.001). Lymph node invasion was more common in CGC patients than in DTGC patients (p< 0.01). Multivariate analysis showed that patient age, lymph node status, and resection with curative intent were significant prognostic factors for the survival of CGC patients. Of the patients who underwent tumor resection with curative intent, the 5-year survival rate of CGC patients was lower than that of DTGC patients (57.4 vs. 63.1%), but no significant difference was observed between the two groups (p> 0.05). When the CGC group was divided into patients who underwent resection with or without curative intent, the 5-year survival rates were 52.8 and 6.0%, respectively (p< 0.001). CONCLUSION: According to our results, curative resection itself, rather than tumor location, was the determining factor in improving 5-year survival.     

Mean and long-term results of the surgical treatment of early gastric cancer

AIM: Interest in the diagnosis and treatment of early gastric cancer (EGC) has been steadily increasing due to the high 5-year survival rate which can reach 85-100% after curative resection. The aim of this retrospective study was to analyze the clinical and histologic characteristics as well as the results of 45 patients undergoing surgical resection for EGC. METHODS: Between 1998 and 2004, 45 patients, 14 females and 31 males with a mean age of 60.2+/-15 years (range: 31-85) were recruited. Subtotal gastrectomy was performed in 28 (62.2%) patients and total gastrectomy in 17 (37.3%). D1 and D2 resections were performed in 36 and 9 patients, respectively. The carcinoma was limited to the mucosa in 26 (57.8%) patients and extended into the submucosa in 19 (42.2%). Lymph node invasion occurred in 4 (8.8%) patients. Mean follow-up was 36 months (range: 3-63). Survival was calculated using the Kaplan-Meier method. Multivariate analysis of clinic and histologic factors was performed to identify predictive factors for survival. RESULTS: The 5-year actuarial survival rate was 85% and there was no postoperative mortality. Statistical analysis did not demonstrate any significant statistical relationship between survival and parietal penetration (P = 0.67) or superficial extension (P = 0.38) of the tumor. Survival was clearly influenced (P < 0.001) by lymph node involvement. CONCLUSIONS: Prognosis of EGC is usually excellent but can be influenced by the presence of lymph node metastases.     

胃癌肝转移的肝切除治疗及预后分析

目的 探讨胃癌肝转移肝切除治疗的疗效以及不同临床病理因素与预后的关系.方法 回顾性总结24例胃癌肝转移行肝转移灶手术切除患者的临床资料并对预后进行单因素和多因素分析.结果 全组病例均获得随访,胃癌肝转移外科治疗后1年生存率为67%,3年生存率为21%,5年生存率为13%.单因素分析显示淋巴结转移、脉管瘤栓、R0切除、转移灶大小为重要预后因素;多因素分析显示转移灶大小、脉管瘤栓为独立预后因素.结论 严格适应证的胃癌肝转移手术切除可以改善预后.综合治疗有望进一步提高疗效.     

Surgical outcomes in patients with T4 gastric carcinoma

BACKGROUND: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. STUDY DESIGN: We used univariate and multivariate analyses to review the surgical outcomes and prognostic factors of 117 patients who underwent surgery for T4 gastric carcinoma. RESULTS: Curative resection was performed in 38 (32.4%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 16.0% and the median survival time (MST) was 11 months for all 117 registered patients. The 5-year survival rates and MSTs in patients after curative and noncurative resection were 32.2% versus 9.5% and 20 months versus 8 months, respectively. These values differed considerably between the two groups (p < 0.0001). Curability was an independent prognostic factor among all registered patients, including those who underwent noncurative resection. A relatively small tumor diameter (< 100 mm) and few lymph node metastases (six or fewer metastatic lymph nodes) were independent prognostic factors when curative resection could be performed. Postoperative morbidity and mortality were acceptable after curative combined resection. CONCLUSIONS: We recommend the use of aggressive combined resection of adjacent organs, with extended lymph node dissection, for patients with T4 gastric carcinoma in whom curative resection can be used; that is, those with few metastatic lymph nodes (six or less) and a relatively small tumor diameter (100 mm). But noncurative resection should be avoided in patients with T4 gastric cancer.     

胃底贲门癌侵及胰体尾外科治疗的预后分析

目的探讨影响胃底贲门癌侵及胰体尾外科治疗预后的因素。方法对135例胃底贲门癌侵及胰体尾患者进行手术,其中剖腹探查术20例,联合脾及胰体尾切除术115例。对影响手术的预后进行单因素及多因素分析,并分析术后的并发症发生率和病死率。结果剖腹探查术和联合脾及胰体尾切除术患者的中位生存期分别为4．7个月和30．5个月,差异有统计学意义（X^2=403．8,P〈0．01）。联合脾及胰体尾切除术患者的3、5年生存率分别为48．3％、26．6％;肿瘤的直径、大体分型、浸润深度、淋巴结转移、No．10或No．11淋巴结转移、根治程度和受侵脏器切除数目为影响预后的相关因素;其中浸润深度、淋巴结转移分期、手术根治程度及受侵脏器切除数目为影响预后的独立因素。术后并发症发生率和病死率分别为20．0％和3．5％。结论对于胃底贲门癌侵及胰体尾患者,施行联合脾及胰体尾切除术能够提高疗效。如果患者无淋巴结转移、或无不可根治因素存在、或无合并其他脏器受侵,施行联合脾及胰体尾切除术疗效最好。     

胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料,对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例,5年生存率14．7％,明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示,浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355,P=0．012）和肝转移数目（RR：7．664,P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。     

Long-term results of surgical resection of locally advanced colorectal carcinoma

This study was undertaken to review the long-term results of multivisceral resection of locally advanced colorectal carcinoma. Between 1964 and 1980, 1042 patients underwent exploratory surgery for colorectal cancer. Of these, 58 patients (5.5%) underwent curative multivisceral resection for suspected contiguous invasion by the primary tumor. Follow-up was complete for all patients. The primary tumors were located in the rectum (38 patients), sigmoid (9 patients), left colon (6 patients), and right colon (5 patients). En bloc resection of other viscera included uterus, adnexa, bladder, vagina, small intestine, abdominal wall, liver, stomach, kidney, and ureter. The operative morbidity and mortality rates were 31% and 1.7%, respectively. Resection margins were free of tumor in 54 patients. In the four patients with tumor-positive resection margins, recurrence of disease was evident between 8 and 22 weeks after surgery (mean survival time, 8.2 months). Carcinomatous invasion of the resected contiguous organ was confirmed in 49 patients (84%). The mean survival time for patients without lymph node metastases was 100.7 months, but it was only 16.2 months (p less than 0.01) for patients with lymph node metastases. Actuarial 5-year disease-free survival rate for patients without lymph node metastases was 76% (36 of 47 patients). None of the patients (0 of 11) with lymph node metastases survived for 5 years. Three of 36 of the 5-year survivors experienced recurrence of disease before the seventh postoperative year; no cancer-related deaths occurred between 7 and 25 years. These data suggest that survival in locally advanced colorectal carcinoma is more dependent on lymph node status than on the extent of local invasion. Effective disease control associated with survival in the long term can be achieved by multivisceral resection.