- 期刊
En bloc Resection in Multivisceral Resection to Treat Adenocarcinoma of the Colon
探討完整切除對於大腸癌併多器官切除之重要性
摘要
Purpose. The aim of this study was to determine the outcome of en bloc resection in patients with adenocarcinoma of the colon. Methods. Patients with locally advanced colon cancer who underwent surgery at Kaohsiung Veterans General Hospital between January 2004 and December 2012 were included. The records of all patients who underwent en bloc resection or non-en bloc resection were analyzed, retrospectively. The overall and disease-free survival (OS and DFS, respectively) rates were evaluated using the Kaplan-Meier method. Results. In total, 1638 patients had colorectal adenocarcinoma; of these, 138 patients had locally advanced adenocarcinoma of the colon, including 83 men and 55 women, with a mean age of 64 years. Of these, 108 patients underwent en bloc resection and 30 did not (non-en bloc). The 5-year OS rate in the en bloc group was 22%, whereas in the non-en bloc group, it was 19% (p = 0.012). The 5-year DFS in the en bloc group was 70.9%, whereas in the non-en bloc group, it was 52.5% (p = 0.015). Conclusions. En bloc resection could provide good prognosis in patients with locally advanced colon cancers. However, if en bloc resection is considered difficult, to ensure a good DFS rate, wide excision should be performed.
並列摘要
目的：手術時發現有局部侵犯及發炎的大腸癌建議做同時完整切除沾黏鄰近器官會有較好的預後，但過去醫學文獻報導發表個案數少，且有時因手術複雜需實施分段切除，比較本院過去病例找出可能影響的因素以及兩者預後的差別。方法：從2004 年1 月至2012 年12 月間，收集高雄榮民總醫院外科部大腸直腸外科有接受手術發現局部侵犯的大腸癌病例。回朔性地回顧完整切除腫瘤及鄰近器官和分段切除的病例，比較這兩組病人的病理切片，治療和癒後，將資料統計分析並比較其中的差異加以呈現。結果：共1638 位大腸直腸癌病患在期間內接受手術，138 位病患（83 位男性、55 位女性）有局部侵犯的大腸腫瘤被收錄於研究中。108 位接受完整切除腫瘤及鄰近器官，30位接受分段切除。兩組間年齡、性別、腫瘤分期和部位無明顯差異。五年存活率分別為22%（完整手術切除）和19%（分段手術切除）(p = 0.012)。五年無復發率為70.9% (完整手術切除) 和52.5%（分段手術切除）(p = 0.015)。結論：依本研究的解果，完整切除局部侵犯的大腸癌和所沾黏的鄰近器官有較好的預後。此外，如無法實施同時切除也應盡量以分段切除沾黏器官，令邊緣達到安全範圍，降低復發率。