Long-term Outcome of Colectomy for T1 Colon Cancer after Endoscopic Polypectomy

經內視鏡切除術後的pT1大腸癌病人，接受腸切除手術之長期預後探討

巫旻憲(Ming-Hsien Wu) ； 陳周斌(Joe-Bin Chen) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Shone Chen) ； 林楨國(Jen-Kou Lin) ； 岳德政(Te-Cheng Yueh) ； 姜正愷(Jeng-Kai Jiang)

《中華民國大腸直腸外科醫學會雜誌》 27卷4期 (2016/12) Pp. 155-161

https://doi.org/10.6312/SCRSTW.2016.27(4).10512

摘要

目的 這項研究評估比較內視鏡切除術後的pT1大腸癌病患接受腸切除的長期存活。方法 從2000年1月至2010年12月，經內視鏡切除術後的pT1大腸癌病患接受過腸切除手術治療的病患均收入研究。研究主要對於根除性腸切除及限制性腸切除兩組作分析，比較淋巴轉移，復發率及存活率。結果 共計68位病患被納入這項研究。其中27位接受局限制性腸切除，另外41位接受根除性腸切除。局限制性腸切除組病人淋巴轉移比例較高(11.1% vs. 0%, p = 0.029)。根除性腸切除組摘除的淋巴結數目較多(10.7 ± 6.9 vs. 7.3 ± 5.4, p = 0.034)，限制性腸切除組淋巴轉移率較高(11.1% vs. 0.0%, p = 0.029)。兩組在復發率 (3.7% vs. 0.0%, p =0.214)，五年整體存活率(95.5% vs. 97.5%, p = 0.373)及無病存活率(95.5% vs. 97.5%, P= 0.354)並沒有統計上的差異。限制性腸切除組復發率有較高的趨勢(3.7% vs. 0.0%, p = 0.214)。兩組均沒有因手術造成的死亡。手術併發症為較差預後的獨立影響因子，然而手術併發症在兩組間沒有差異。結論 經內視鏡切除術後的pT1大腸癌病患，雖然限制性腸切除組淋巴轉移率較高，但是根除性腸切除組及限制性腸切除組在預後方面就復發率，整體存活率及無病存活率方面無差異。此外，兩組在手術併發症及死亡率方面無差異。

關鍵字

pT1大腸癌 ； 根除性腸切除 ； 限制性腸切除

並列摘要

Purpose. This study aimed to compare the long-term outcomes between radical and limited colectomy for patients with pT1 colon cancer after endoscopic resection. Methods. The clinical data of patients who underwent colectomy for pT1 colon cancer after endoscopic polypectomy from January 2000 to December 2010 were reviewed from a prospectively constructed database. Clinico-pathological features and oncological outcomes were compared between radical colectomy and limited colectomy groups. Results. A total of 68 patients were included in this study. Twenty-seven patients underwent limited colectomy and 41 underwent radical colectomy. The latter group had more harvested lymph nodes (10.7 ± 6.9 vs. 7.3 ± 5.4, p = 0.034), while the former group had a higher lymph node metastatic rate (11.1% vs. 0.0%, p = 0.029). The recurrence rate (3.7% vs. 0.0%, p = 0.214) and overall (95.5% vs. 97.5%, p = 0.373) and disease-free survival (95.5% vs. 97.5%, p = 0.354) did not differ significantly between the groups. No surgery-related deaths occurred, and the rate of surgical complications did not differ between the groups; however, the presence of complications was an independent prognostic factor for poor disease- free survival. Conclusions. Although the lymph node metastatic rate was higher in the limited colectomy group, the oncological outcome in terms of recurrence rate and overall and disease-free survival did not differ between radical and limited colectomy for pT1 colon cancer after endoscopic polypectomy. Additionally, there was no difference in surgical morbidity and mortality between the groups.

並列關鍵字

pT1 colon cancer ； Radical colectomy ； Limited colectomy

參考文獻

1. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009;22(4):191-7.

2. Lorenzon L, Pilozzi E, La Torre M, Ziparo V, Ferri M. Impact and prognostic implications of colon cancers stage II sub-classification through the years. Int J Colorectal Dis 2012;27(10):1311-8.

3. La Torre M, Lorenzon L, Pilozzi E, Barucca V, Cavallini M, Ziparo V, et al. Number of harvested lymph nodes is the main prognostic factor in Stage IIa colorectal cancer patients. J Surg Oncol 2012;106(4):469-74.

4. Dias AR, Nahas CS, Marques CF, Nahas SC, Cecconello I. Transanal endoscopic microsurgery: indications, results and controversies. Tech Coloproctol 2009;13(2):105-11.

5. Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 2005;48(4):711-21.