复发大肠癌230例的临床特征及再次根治性手术的价值

目的探讨大肠癌复发的临床特征、原因以及再次根治性手术的价值。方法回顾性分析230例复发大肠癌患者的临床病理资料、复发特征及再次根治性手术后生存情况。结果直肠癌在术后30个月内复发率迅速上升，中位复发时间是18．6个月；结肠癌在术后20－40个月复发率上升较快，中位复发时间是23．4个月；结肠癌早期复发时间较直肠癌晚，复合复发时间晚于单部位复发时间（P〈0．05）。结肠癌首次复发后再次根治性切除率高于直肠癌（P〈0．05）。单因素分析显示原发肿瘤位置、浸润的深度、淋巴结转移数目、肿瘤的病理类型、术中化疗与否、血管是否有癌栓和早期复发有关（P〈0．05），但多因素分析显示只有肿瘤浸润深度是独立影响因素。复发病例再次根治性手术者5年生存率明显高于无法根治性手术者。结论大肠癌早期复发高峰在术后40个月内，肿瘤浸润深度是独立影响因素。而原发肿瘤位置、淋巴结转移数目、肿瘤的病理类型、术中化疗与否、血管是否有癌栓是影响早期复发的重要因素。复发病例再次根治性手术可以改善其预后。

Clinical features and value of radical re-operation of recurrent colorectal cancer

Objective To investigate the clinical features,affecting factors of recurrent colorectal cancer and study the value of radical re-operation for these patients.Methods A retrospective analysis of pathological data clinical characteristics and survival after radical reoperation in 230 recurrent colorectal cancer patients.Results For rectal cancer,relapse rates was rising rapidly in 30 months,median time to relapse was 18.6 months;as for colon cancer,relapse rates rose faster during 20-40 after radical operation;median time to recurrence was 23.4 months.Recurrence occurred later in colon cancer than rectal cancer.Time of multiple sites recurrence was later than that of single sites recurrence,P < 0.05.Radical resection rates after first relapse was higher in colon cancer versus rectal cancer,P < 0.05.Single factor analysis showed that the location of primary tumor,infiltrating depth,number of metastic lymph node,microscopic types of tumor,intraoperative chemotherapy and tumor emboli in vessles were relevant with early recurrence,P < 0.05,but multiple factors analysis showed that only infiltrating depth was independent affecting factor.The 5-year survival rate were obviously higher in patients who accepted radical surgery again versus those who couldn’t undergo radical surgery.Conclusions In colorectal cancer,peak of early recurrence is in 40 months postoperatively,tumor infiltrating depth is independent affecting factor,location of primary tumor,number of metastatic lymph node,microscopic types of tumor,intraoperative chemotherapy or not and tumor emboli in vessles are important factors affecting early recurrence.Radical re-operation can improve the prognosis in recurrent patients.