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| 題 名 | Long Term Outcome of Local Excision for T1-2 Rectal Cancer=T1-2直腸癌經局部切除手術後之長期結果 |
|---|---|
| 作 者 | 徐宇辰; 張世慶; 林資琛; 陳維熊; 姜正愷; 楊純豪; 王煥昇; 林楨國; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
| 卷 期 | 19:3 2008.09[民97.09] |
| 頁 次 | 頁78-86 |
| 分類號 | 416.245 |
| 關鍵詞 | 直腸癌; 局部切除手術; T1&T2癌; Rectal cancer; T1 & T2 cancer; Local excision; |
| 語 文 | 英文(English) |
| 中文摘要 | 目的 對於中低位之直腸癌,局部切除手術因具有較低的罹病症及較佳的功能結果,可視為另一選擇的手術方式。我們回顧本院早期直腸癌接受局部切除後長期之結果。 病患及研究方式 我們回顧從1982 年1 月到2004 年12 月,診斷為中低位 (距肛門口10 公分以內) 之T1-2 直腸癌,接受局部切除手術之病患資料及其病理切片。共有76 位患者,其中44 位為T1 及32 位為T2。有11 位患者接受術後放射線治療。資料分析包含臨床特性及病理特徵。腫瘤復發分為局部、遠端復發,或兩者皆有。59 位病患 (77%) 追蹤至病逝或五年以上;51 位病患 (67%) 追蹤至病逝或十年以上。資料結果包括五年及十年的腫瘤復發率、癌病存活率、及無復發存活率。 結果 對於十年之腫瘤局部復發率及全復發率,T1 分別為9.1% 及15.9%,T2 分別為 12.9% 及21.9%。對於五年及十年之癌病存活率,T1 為97.2% 及92.1%,T2 為83.9% 及76.3%。多變異分析結果顯示,癌病存活率之預後因子為腫瘤侵犯深度及血管有無侵犯。無復發存活率之預後因子則為血管侵犯與否。在八位腫瘤局部復發的病患當中,有五位接受救癒性手術,其無復發存活率為60%,平均追蹤時間為七十七個月。 結論 就長期追蹤而言,局部切除手術對於中低位之T1 直腸癌有不錯的結果,但對於 T2 直腸癌則因存活率較差而不甚理想。病理上有無血管侵犯可視為癌病存活率及無復發存活率之預後因子。 |
| 英文摘要 | Purpose. Local excision is an alternative method of treatment for middle to low rectal cancer due to low morbidity and good functional result. We reviewed the experience with local excision of early rectal cancer to evaluate the long term result. Patients&Methods. Between January 1982 and December 2004, patients with T1-2 adenocarcinoma of the middle to lower rectum (below 10 cm from anal verge) treated by local excision were reviewed. The pathology of specimen was reviewed. Seventy-six patients were assessed and 44 were T1 and 32 were T2 cancers. Eleven patients received adjuvant radiation therapy. Data analysis included clinical characteristics and pathological features. The tumor recurrence was identified as local, distant or both. 59 patients (77%) were followed until death or more than five years and 51 patients (67%) were followed until death or more than ten years. The outcomes were defined as five-year and ten-year cumulative data of tumor recurrence rate, cancer-specific and disease-free survival rates. Results. The ten-year local and overall recurrence rate were 9.1% and 15.9% for T1 lesion and 12.5% and 21.9% for T2 lesion. The five-year and ten-year cancer-specific survival rates of T1 lesion were 97.2% and 92.1% and of T2 lesion were 83.9% and 76.3%. On multivariate analysis, the significant prognostic factors of cancer-specific survival rate were T stage (p = 0.038) and angio-vascular invasion (p < 0.001). The only significant factor of disease-free survival rate was angio-vascular invasion (p < 0.001). Of the eight patients who had isolated local recurrence, five patients received salvage surgery and the disease-free survival rate was 60% with mean follow up of 77 months. Conclusion. Local excision for middle to lower T1 rectal cancer is acceptable with good long-term result but is not considered in T2 lesion due to unsatisfied cancer-specific survival rate. The pathological feature of angio-vascular invasion seems to be the prognostic factor of diseasefree and cancer-specific survival. |
本系統中英文摘要資訊取自各篇刊載內容。