Transanal Local Excision Versus Radical Surgery for T1N0 Lower Rectal Adenocarcinoma

T1N0低位直腸腺癌之經肛門局部切除術與根治手術之比較

林雅慧(Ya-Huei Lin) ； 洪欣園(Hsin-Yuan Hung) ； 陳進勛(Jinn-Siun Chen) ； 王正儀(Jeng-Yi Wang) ； 張簡俊榮(Chung-Rong Changchien) ； 唐瑞平(Rei-Ping Tang) ； 游耀東(Yau-Tong You) ； 江支銘(Jy-Ming Chiang) ； 葉建裕(Chien-Yuh Yeh) ； 謝寶秀(Pao-Shiu Hsieh) ； 蔡文司(Wen-Sy Tsai) ； 游正府(Jeng-Fu You) ； 蔣昇甫(Sum-Fu Chiang) ； 賴正洲(Cheng-Chou Lai)

《中華民國大腸直腸外科醫學會雜誌》 25卷4期 (2014/12) Pp. 141-150

https://doi.org/10.6312/SCRSTW.2014.25(4).10320

摘要

目的　本研究的目的是比較治療T1N0期直腸癌利用經肛門局部切除手術或根治性手術其二者效果和生存率是否有差異。方法　我們回顧性分析在1995年5月至2013年1月間，患者全部都是T1期直腸腺癌（病理pT1期無手術前輔助化療或放射治療）。其中有87例患者接受經肛門局部切除術和176例患者接受根治性手術治療。結果　平均年齡，性別分佈，癌胚抗原水平（CEA）的結果在這2組間是相似的。平均住院時間在局部切除術這組為4.66天，而在根治性手術組為12.32天（p＜0.05）。5年總生存率（overall survival），在局部切除術這組為為91%，而在根治性手術組為83%（p =0.928）。5年無病生存期（disease-free survival），在局部切除術這組為87%，而在根治性手術組為93%（p=0.037）。局部切除術這組的5年無病生存期（disease-free survival）顯著較差。結論　局部切除是治療早期低位直腸癌腺癌的一種替代方法。經篩選後局部切除術其預後是與根治性手術相似。局部切除術的優點包括早期腸道功能恢復，縮短住院時間，降低併發症和避免人工造口形成。

關鍵字

直腸惡性腫瘤 ； 局部切除 ； 存活率

並列摘要

Background. The aim of this study was to compare surgical outcomes including survival in T1N0 rectal adenocarcinoma patients undergoing transanal local excision or radical surgery. Methods. We retrospectively reviewed 87 and 176 patients who underwent transanal local excision and radical surgery, respectively, for T1N0 rectal adenocarcinoma without neoadjuvant chemotherapy or radiotherapy between May 1995 and January 2013. Results. The mean age, sex distribution, and carcinoembryonic antigen level were similar between the 2 groups. The mean duration of hospital stay was 4.66 days in the local resection group and 12.32 days in the radical surgery group (p＜0.05). The overall survival rate at 5 years was 91% in the local resection group and 83% in the radical surgery group (p=0.928). The disease-free survival rate at 5 years was 87% in the local resection group and 93% in the radical surgery group (p=0.037). The disease- free survival rate at 5 years in the local resection group was significantly poorer than in the radical surgery group. Conclusion. Local excision is an alternative method of treatment for early lower rectal adenocarcinoma. With selection, the oncologic outcomes for local excision are similar to that of radical surgery. Advantages of local excision include early bowel function recovery, shorter hospital length of stay, lower morbidity, and avoidance of colostomy.

並列關鍵字

Rectal adenocarcinoma ； Local excision ； Survival

參考文獻

5. Yu-Chen Shiu, Shih-Ching Chang, Tzu-Chen Lin, Wei-Shone Chen, Jeng-Kae Jiang, Shung-Haur Yang, et al. Long Term Outcome of Local Excision for T1-2 Rectal Cancer. J Soc Colon Rectal Surgeon (Taiwan) 2008; 19:78-86

1. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann. Oncol 2012; 23(10):2479-516.

2. Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer. Dis. Colon Rectum 2013; 56(5):535-50.

3. Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Riansuwan W, et al. Outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain, and risk factors for anastomotic leakage. Dig Surg 2008; 25(3):191-7.

4. Heintz A, Morschel M, Junginger T.: Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 1998; 12(9):1145-8.