结直肠癌局部复发的外科治疗

目前，外科手术依然是可治愈结直肠癌的惟一手段。虽然外科治疗水平有了长足进步，但结直肠癌的5年生存率仍无显著提高。手术后肿瘤复发和转移是导致结直肠癌治疗失败的主要原因。尽管近年来采用全直肠系膜切除手术提高了直肠癌根治率，但术后复发在临床上仍很常见。就结直肠癌术后的局部复发来看，结肠癌的局部复发率为3．1％～25．6％；直肠癌局部复发率为4％～40％。     

直肠癌术后局部复发的外科治疗

局部复发是直肠癌治疗失败的主要原因之一。对直肠癌术后局部复发，根治性手术RO是目前获得治愈的唯一治疗措施，因此，首选外科治疗：应当依据合理的术前检查及术中探查，在判断复发的位置和侵袭范围后，严格遵循手术的适应症和禁忌症，必要时联合围手术期辅助治疗或进行盆腔脏器联合切除，以达到根治性切除。同时，应积极进行多学科的综合治疗，以改善患者的生存质量，延长患者的生存期。     

提高对结直肠癌术后复发和转移的诊治水平

全世界结直肠癌发病率仍处于上升趋势 ,平均每年递增 2 %。在欧美国家其死亡率仍居癌症死亡的第二位。我国情况亦相似 ,以上海为例 ,发病率年递增 4.2 %,比全球平均递增速度还要高一倍多。1 990～ 1 992年我国十分之一人口抽样调查 ,结直肠癌平均调整死亡率为 4.5 4 / 1 0万 ,居癌症死亡第五位 [1] 。　　在治疗上 ,结直肠癌治疗效果还不够理想 ,近三十多年来提高并不显著。美国癌症协会 Cutler统计分析 2 5 0 0 0例结直肠癌资料 ,外科治疗结肠癌 5年生存率从 1 940～ 1 96 0年由 48%提高到 5 6 %;直肠癌由 44%提高到 5 0 %。英国牛津大学…     

肿瘤干细胞与结直肠癌的转移和复发

结直肠癌是人类最常见的恶性肿瘤之一,其发病率和死亡率分别居所有癌症的第三位和第四位。一旦发生转移或复发,其预后将极差。因此,如何预防结直肠癌转移和复发是结直肠癌治疗成败的关键。     

Dukes B期结直肠癌根治术后复发转移分析

目的探讨Dukes B期结直肠癌根治术后复发转移相关的临床病理因素。方法应用单因素分析法，回顾性分析1990—1999年265例Dukes B期结直肠癌根治术病例的临床病理因素。结果单因素分析显示，Dukes B期大肠癌的预后与肿瘤部位有关，直肠癌术后更易发生复发转移，特别是局部复发。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度、肠壁浸润深度与术后复发转移无关。结论Dukes B期的直肠癌患者术后局部复发的风险较大。     

结直肠癌肝转移术后肝内复发的再治疗

外科手术切除结直肠癌肝转移灶后患者的5年存活率虽可达20%,但术后肝内再次复发转移并不少见[1]。我院1993年6月至2003年6月间71例结直肠癌肝转移患者接受外科治疗,其中22例(31.0%)肝癌复发,18例再次接受治疗。     

结直肠癌肺转移的外科治疗原则

结直肠癌是常见的恶性肿瘤之一,我国结直肠癌每年发病患者数为15．06万,每年死亡人数为8．61万。在我国恶性肿瘤发病率和死亡率中,结直肠癌均为第5位,其中女性为第6位（WHO,2002）。发病率和死亡率均呈上升趋势。我国卫生部2003年12月颁布的《中国癌症预防与控制规划纲要》（2004—2010年）中,被列为重点防治的8种恶性肿瘤中,结直肠癌排在第5位。     

结直肠癌的局部复发

结直肠癌的局部复发是在治愈性切除中一个重大问题，影响其发生的重要因素有肿瘤分级，固定程度，瘤在直肠的平面，血管和淋巴管受侵，切除时意外穿破肿瘤以及外科医师的经验。彻底切除和辅助治疗可防止其发生。     

努力提高结直肠癌外科治疗的疗效

结直肠癌是常见的恶性肿瘤,其在美国的发病率居恶性肿瘤的第4位,死亡率位居恶性肿瘤的第2位。据2005年统计,美国新发结直肠癌病例达146000例。在我国结直肠癌发病率居恶性肿瘤第3～5位。据预测,我国结直肠癌的发病率与死亡率在今后很长一段时期内还将呈上升趋势,因此提     

结直肠癌外科治疗水平差异的思考

我国结直肠癌的治疗水平差异甚大这是不争的事实，不同医院之间有差异，大小城市之间有差异，同一医院医生个体之间也有差异。这种差异产生的可能因素有以下几点：（1）肿瘤临床病理分期不严密，如送检淋巴结数量不够或未能了解肿瘤穿透肠壁或浸润周围脏器时有无伴发微灶播散等；（2）没有严格的机制来规范手术操作程序和方法，如“不接触技术（notouch）”的采用，术中是否化疗等；（3）外科医生手术技巧的个体差异；（4）有无采用外科手术治疗以外的综合性辅助治疗措施。如何缩小外科治疗效果的差异，是我国结直肠外科专业学组及有关的专业委员会应该思考的问题。     

Locally recurrent colorectal cancer: results of surgical therapy

Purpose

Up to 20?% of colorectal cancer patients develop recurrent disease despite standardized surgical techniques and multimodal treatment strategies. Radical resection is the central component of curative therapy in these cases. The aim of this study was to evaluate treatment results in patients with locoregionally recurrent colorectal cancer.

Methods

From January 1995 to December 2007, surgery was performed for recurrent colorectal cancer in 82 patients who had undergone curative (R0) resection of their primary tumor. Assessment included patient, tumor and treatment characteristics, postoperative complications, and time without re-recurrence; recurrence-free and overall survival rates were calculated according to the Kaplan–Meier method.

Results

Resection was performed in 60 of the 82 patients (73?%), repeat R0 resection in 52?% (31/60). Patients had a postoperative morbidity of 39?% (31/82), a relaparotomy rate of 13?% (11/82), and a lethality of 7?% (6/82). Forty-eight percent of all surgically-treated patients received a permanent stoma. Re-recurrence was seen in 52?% (16/31). R0 resection was associated with a 5-year survival rate of 35?% (11/31).

Conclusions

Extensive reinterventions often enable repeat R0 resection. Despite relevant morbidity, the lethality appears to be acceptable. Decisive for the prognosis is re-recurrence.     

Aggressive surgical approach to recurrent tumors after hepatectomy for metastatic spread of colorectal cancer to the liver

BACKGROUND: Liver resection is currently accepted as the only potential cure for patients with metastases of colorectal tumors in the liver. However, cancer will recur in more than 70% of patients. METHODS: In the 7 years to December 1997, 60 patients underwent liver resections for colorectal metastases at our institute. Of these, 20 patients had repeated surgical resections for recurrent disease of the liver and other organs. Another 2 patients had undergone previous hepatectomy elsewhere. The clinical data for these patients were reviewed. RESULTS: The median interval between the 2 resections was 16 months. Eighteen hepatectomies, 6 lung resections, and 1 pancreatoduodenectomy were performed in 22 patients. Operative mortality and complication rates were 0% and 18%, respectively. At a median follow-up of 25 months after repeated resection, the survival rate in these patients was 73% at 2 years (12 of 16 evaluable patients are surviving) and 22% at 5 years (2 of 10 evaluable patients are surviving); the median survival time was 44 months. CONCLUSIONS: Repeated resections for recurrent colorectal metastases yield comparable results to first liver resections in operative mortality and morbidity rates, survival time, and pattern of recurrence. Although the number of patients surviving more than 5 years is still limited, the absence of other proven treatments supports the concept of an aggressive resectional approach for these patients.     

无法治愈的结直肠癌的姑息性外科治疗

在结直肠癌局部广泛侵犯或者出现全身多处转移、无法切除全部的原发灶和（或）转移灶时,肿瘤已进展到无法治愈的阶段。此时虽然不可能治愈,患者也应该接受姑息性治疗。一旦这些患者出现肠梗阻、肠穿孔等急性并发症,就需要外科会诊考虑是否进行姑息性手术。此时手术危险性极高,特别是那些伴随疾病较多的老年患者,由于肿瘤进展体质更加虚弱。姑息性外科治疗是目前结直肠癌肿瘤外科领域争论最多的热点之一。     

结直肠癌肝转移外科手术新理念

结直肠癌肝转移发生率高,约60％结直肠癌患者最终将发生肝转移,其中30％转移灶局限于肝脏,这为外科治疗提供了有利条件。按照传统的外科手术标准只有约10％～15％结直肠癌肝转移适合手术切除,但是随着手术理念的更新、新化疗药和化疗方案的出现、局部消融方法的应用,结直肠癌肝转移可切除病例数正逐渐增多。结直肠癌肝转移患者的5年总生产率从30％提高到60％。     

Clinical review: surgical management of locally advanced and recurrent colorectal cancer

Aim

Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

Methods

A literature review was performed on the electronic databases MEDLINE from PubMed, EMBASE and the Cochrane library for publications in the English language from January 1993 to July 2013. The MeSH search terms ‘locally advanced colorectal cancer’, ‘recurrent colorectal cancer’ and ‘surgical management’ were used.

Results

A total of 1,470 patients with recurrent or locally advanced primary colorectal cancer were included in 22 studies. Surgical removal of the tumour with negative margins (R0) offers the best prognosis in term of survival with a 5-year survival of up to 70 %. MVR is needed in approximately 10 % with the most commonly involved organ being the bladder. The mean post-operative morbidity is 40 %, mainly relating to superficial surgical site infection, pelvic collections and delayed wound healing. Most patients will undergo radiotherapy and/or chemotherapy pre- or post-operatively. The mean 5-year overall survival for R0 resection is 50 % for recurrent and locally advanced primary tumours while survival following R1 or R2 is 12 and <5 %, respectively.

Conclusion

Multimodal therapy and extended surgery to achieve clear margins offers good prognosis to patients with recurrent and locally advanced colorectal cancers.     

Meta-analysis of new treatment strategies for metastatic colorectal cancer

Metastatic disease is present at diagnosis in 30% of the patients with colorectal cancer (CRC), and approximately half of early-stage patients with CRC will eventually present with metastatic disease. Until recently, few chemotherapy options were available to treat metastatic colorectal carcinoma (MCRC). Fluorouracil (5-FU) with leucovorin (LV) modulation has a marginal but positive effect on survival in those patients. The recent incorporation of irinotecan (CPT-11) and oxaliplatin for the management of advanced CRC has generated further improvement in survival. The development of oral fluoropyrimidines, mimicking continuous infusion 5-FU, is convenient to use. Recently completed or ongoing clinical trials to study novel targeting agents have initiated a new era of drug development. Anti-angiogenesis drugs, tyrosine kinase inhibitors, and epidermal growth factor blockers are among the new generation of agents.     

结肠癌术后复发的外科治疗及预后分析

目的探讨结肠癌术后复发的外科治疗及影响患者预后的因素。方法回顾性分析我院1997年1月至2005年12月外科治疗的102例结肠癌复发病例的临床资料。应用SPSS11．5对随诊资料进行统计学分析,采用r检验分析其相关因素,Kaplan—Meier法进行生存分析,Log。rank检验进行统计学比较。应用COX比例风险模型进行多因素分析。结果单因素统计分析显示原发肿瘤梗阻情况、再手术前的癌胚抗原水平、复发部位的多少、复发间隔时间和再手术方式是影响预后的主要因素,多因素统计分析显示复发部位的多少,再手术方式是影响预后的最重要因素。结论积极的外科治疗,争取行根治性切除手术,可以延长复发性结肠癌患者的生存期。