Diagnosis of Adjacent Organ Invasion and Results from En Bloc Extended Resection for Locally Advanced Colorectal Cancer

大腸直腸癌併周邊器官侵犯之手術治療

陳建勳(Jian-Syun Chen) ； 陳明仁(Ming-Jen Chen) ； 許自齊(Tzu-Chi Hsu)

《中華民國大腸直腸外科醫學會雜誌》 25卷3期 (2014/09) Pp. 92-100

https://doi.org/10.6312/SCRSTW.2014.25(3).10315

摘要

目的　手術治療目前仍是治癒大腸直腸癌的唯一希望。然而，有時大腸直腸癌會併發周邊器官侵犯。切除周邊受侵犯器官，不僅能解除病人症狀，對於疾病根治也有很大的幫助。本研究為回溯分析手術切除大腸直腸癌併周邊器官侵犯之經驗。方法　自2000年1月至2009年12月，共1583位病患接受單一外科醫師手術治療大腸直腸癌。其中36位病人（2.27%）因癌症侵犯周邊器官，同時接受周邊器官切除。共有17位男性及19位女性，年齡介於28至84歲之間（平均年齡60.9歲）。其中19位病人癌症侵犯小腸，14位侵犯泌尿系統，8位侵犯生殖系統。而原發腫瘤有10位為直腸癌，20位為乙狀結腸癌，4位為降結腸癌，1位為升結腸癌，1位為橫結腸癌。這些病人中，不到一半的病人術前能依據影像作出周邊器官侵犯的診斷。結果　3位病人術後發生泌尿道感染，2位發生傷口感染，腸道吻合處滲漏，腸道阻塞，傷口癒合不良，十二指腸潰瘍與穿孔各有一位。手術後死亡率為2.8%（1/36）。結論　大腸直腸癌侵犯周邊器官也許不是很常發生的案例，但此研究分析顯示完整切除受侵犯周邊器官的手術併發症與死亡率是可被接受的。術前完整的腫瘤分析對於腫瘤局部侵犯範圍的掌握有所幫助，但術中良好的手術視野與腫瘤範圍分析更是重要。而各專科醫師的共同努力，合作也更顯重要。

關鍵字

大腸直腸癌 ； 周邊器官侵犯

並列摘要

Purpose. Surgical treatment remains as the only hope of cure for the patient with colorectal cancer. Not infrequently the adjacent organs are invaded by the primary tumor. Resection of organs involved might not only relieve patient's symptoms, but also increase the patient's hope for cure. The study is the retrospective analysis of the diagnosis and treatment of such kind of invasion. Materials and Methods. From January 2000 to December 2009, 1583 cases of primary colorectal cancer were treated surgically by a single surgeon. Thirty-six patients (2.27%) had en bloc resection of locally advanced colorectal cancer with adjacent organ invasion. There were 17 men and 19 women. Age ranged from 28 to 84 years old, with an average of 60.9 years old. Enteral invasion occurred in 19 patients, urinary system involvement in fourteen patients and genital organ invasion in eight patients. Primary colorectal cancer were ten for rectal cancer, 20 for sigmoid cancer, four for descending colon cancer, one each for transverse colon and ascending colon cancer. Less than half of cases were diagnosed with image studies prior to surgery. Results. Complications included three cases of urinary tract infection, two cases of wound infection and one case each for anastomotic leakage, intestinal obstruction, wound dehiscence and duodenal ulcer with perforation. Operative mortality was 2.8% (1/36). Conclusion. This experience suggests that although direct invasion of the adjacent organ by primary colorectal cancer is not common, en bloc resection of the primary tumor with organ involved could be carried out with reasonable morbidity. Appropriate preoperative work up might detect some of the involvement, however, adequate exploration of the abdominal cavity during laparotomy is necessary to determine the extent of involvement. With help of multidisciplinary specialist, en bloc resection of involved organ offers the best interest for the patients.

並列關鍵字

Adjacent organ ； Direct invasion ； Colorectal cancer ； En bloc resection

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