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摘要


目的 評估手術治療局部復發直腸癌的結果,比較手術後存活時間及分析可能達成根治手術的預測因子。 方法 從1994年1月到2005年12月間,共30位病患接受手術治療局部復發直腸癌。所有病患均曾接受過手術切除原發直腸癌而後局部復發。年齡,性別,手術切除直腸癌之醫院、日期、手術方式及輔助治療,局部復發直腸癌之發現日期、表現症狀、及診斷方法,復發腫瘤之位置及鄰近組織侵犯情形,手術前後癌胚抗原濃度等均加以分析。 結果 30位病患之存活時間中位數為16.7個月。有15位病患達成根治手術,另外15位病患則接受緩和手術。根治手術病患之存活時間中位數為28.6個月,緩和手術病患之存活時間中位數為11.9個月。能夠達成根治手術的患者確實能延長存活時間(p=0.014)。比較兩組病患的相關影響因子後,達成根治手術的預測因子如下:有便血等直腸症狀者或無症狀者,復發腫瘤位置在直腸吻合處,及未侵犯鄰近組織者。 結論 治療局部復發直腸癌時,達成根治手術是唯一能延長存活時間的預後因素。達成根治手術的預測因子則提供我們在治療局部復發直腸癌時,作為手術病患選擇及提供適當治療計劃之參考。

並列摘要


Purpose. This study aimed to evaluate surgical results for locally recurrent rectal cancer and to compare median post-operative survival and analyze predictive factors for achieving curative surgery. Methods. Thirty patients who received surgery between January 1994 and December 2005 for locally recurrent rectal cancer were enrolled. All patients had previously undergone radical surgical resection of primary rectal cancer. Age, gender, place of primary surgery, date and type of initial operation, stage of rectal cancer, and administration of adjuvant therapy were retrospectively analyzed. Date of detection, presenting symptoms and diagnostic work-up, location and fixity of recurrent tumor, type of surgery, and pre- and post-operative carcinoembryonic antigen levels were analyzed. Results. The median survival of the 30 included patients was 16.7 months. Curative surgery was achieved in 15 patients and palliative surgery was performed in 15. Median survival was 28.6 months after curative surgery and 11.9 months after palliative surgery (p=0.014). Data showed predictive factors of curative surgery to be rectal symptoms or asymptomatic patients (p=0.014), anastomosis location (p=0.001), and tumor fixity (p<0.001). Conclusions. Curative surgery proved to be the only significant prognostic factor of survival. Predictive factors of curative surgery can therefore be used in the selection of surgical candidates and establishment of appropriate treatment plans.

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