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摘要


Purpose. In recent years, surgery has been believed to provide better prognosis for local recurrence of rectal cancer (LRRC). This study aimed to investigate the role of surgical local control for patients with simultaneous LRRC and distant metastasis. Methods. Thirty patients with LRRC and distant metastasis following curative resection of primary rectal cancer were retrospectively identified from the database at the Taipei Veterans General Hospital from 1999 to 2013. All prognostic factors, including patient information, tumor characteristics, treatment, recurrence and metastasis, were collected and analyzed statistically. Results. Among 30 patients, ten cases underwent surgical resection (SR) for local recurrence, and 20 cases received non-surgical treatment (NST). Surgical indication included intestinal obstruction, tumor bleeding, or ureter invasion with infection. In SR group, only three cases had microscopically negative margins (R0 resection). Overall, the mean interval from the curative resection of the primary cancer to the local recurrence diagnosis was 18.9 months. There were no differences in age, gender, primary tumor stage, tumor histology, local recurrence sites, distant metastatic sites and treatment for distant metastases between these two groups. However, surgery for local recurrences provided no difference in the survival analysis (p = 0.829), while the presence of liver metastasis was the only significant prognostic factor for survival (p = 0.009). Conclusions. Surgery for LRRC alone did not improve the survival of patients who had LRRC with distant metastasis, and liver metastasis was the only significant prognostic factor in these patients.

並列摘要


目的 近年來,研究顯示手術治療對於有直腸癌併局部復發的病人有較好的存活率。而此研究目的在探討直腸癌局部復發並遠端轉移病人接受局部切除之預後。方法 自1999 至2013 年間,自台北榮民總醫院資料庫中回溯性地找出30 名診斷有直腸癌合併局部復發和遠端轉移的病人。我們收集並分析所有的預後因子,如病人基本資料、腫瘤特性、治療方法、復發特質及遠端轉移型態等。結果 在30 名病人中,依據對於局部復發的治療可分成手術切除組 (SR) 及非手術治療組 (NST)。開刀的適應症包括腸阻塞、腫瘤出血、輸尿管侵犯併感染等。在SR 組中,只有3 名病人達到顯微鏡下邊緣無腫瘤侵犯 (R0 切除)。整體來說,平均復發時間是18.9個月。兩組病人在年齡、性別、初始腫瘤期別、腫瘤細胞型態、治療方法、復發位置、及遠端轉移之治療皆沒有統計上差別。然而,採取局部切除的病人的存活時間在統計上並無顯著差別 (p 值 = 0.829);而是否有肝臟轉移反倒是唯一有達到統計上顯著差異的預後因子 (p 值 = 0.009)。結論 對於有直腸癌合併有局部復發及遠端轉移病人而言,只採取局部手術切除並無法改善存活時間。在本研究中,是否有肝臟轉是最重要的預後因子。

並列關鍵字

直腸癌 局部復發 遠端轉移 手術治療 預後

參考文獻


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