Lokalni recidiv kod bolesnika lečenih od karcinoma rektuma metodama totalne mezorektalne ekscizije ili transsekcije mezorektuma

  • Bobana Milojković Clinic for General Surgery,Clinical Center Niš, Niš, Serbia
  • Goran Stanojević Clinic for General Surgery,Clinical Center Niš, Niš, Serbia
  • Zoran Krivokapić First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Nebojša Ignjatović Clinic for General Surgery,Clinical Center Niš, Niš, Serbia
  • Marija Dimitrijević Emergency Center, Clinical Center Niš, Niš, Serbia
  • Mirjana Marinković Clinic for General Surgery,Clinical Center Niš, Niš, Serbia
  • Jelena Ignjatović Faculty of Medicine, University of Niš, Niš, Serbia
  • Miodrag Stojanović Faculty of Medicine, University of Niš, Niš, Serbia
  • Miodrag Djordjević Faculty of Medicine, University of Niš, Niš, Serbia
DOI: https://doi.org/10.2298/VSP150430092M
Ključne reči: rectal neoplasms||, ||rektum, neoplazme, neoplasm recurrence, local||, ||neoplazme, lokalni recidiv, digestive system surgical procedures||, ||hirurgija digestivnog sistema, procedure, surgical procedures, operative||, ||hirurgija, operativne procedure, neoplasm staging||, određivanje stadijuma, prognosis||, ||prognoza,

Sažetak


 

 

Uvod/Cilj. Karcinom rektuma predstavlja veliki medicinski problem širom sveta, uprkos znatnom napretku u lečenju i lokoregionalnoj kontroli bolesti. Cilj rada bio je da se utvrdi uticaj tipa mezorektalne ekscizije na pojavu lokalnog recidiva kod bolesnika operisanih od karcinoma rektuma, u trogodišnjem periodu. Metode. Klinička retrospektivna studija sprovedena je na Klinici za opštu hirurgiju Kliničkog centra u Nišu i obuhvatila je 225 bolesnika operisanih od karcinoma rektuma. Bolesnici su postoperativno  praćeni 36 meseci. Metodom totalne mezorektalne ekscizije (TME) operisano je 129 (57,33%) bolesnika, a metodom parcijalne ekscizije mezorektuma (PME) 96 (42.66%) bolesnika. Muškaraca je bilo 145 (64,44%), a žena 80 (35,55%); prosečna starost 66,8 godina. Rezultati. Kod 58 (25,77%) bolesnika karcinom je bio lokalizovan u proksimalnoj  trećini rektuma, kod 99 (44%) u srednjoj trećini, a kod 68 (30,22%) do 8 cm od anokutane linije. Kod 167 (74,22%) bolesnika karcinom rektuma bio je u T3 stadijumu. Metoda TME primenjena je kod svih bolesnika sa karcinomom u distalnoj  trećini rektuma i kod 61,61% bolesnika sa karcinomom u srednjoj trećini rektuma. Metoda PME primenjena je kod svih bolesnika sa lokalizacijom karcinoma u proksimalnoj trećini i kod 38,38% bolesnika sa lokalizacijom u srednjoj trećini rektuma. Do pojave lokalnog recidiva došlo je kod 20 (8,88%) bolesnika. U grupi TME bilo je 12 (9,30%), a u grupi PME 8 (8,33%) bolesnika sa  lokalnim recidivom, što ne predstavlja statistički značajnu razliku. Kod 75% bolesnika recidiv se javio u T3 stadijumu bolesti. Kod 55% bolesnika lokalni recidiv se javio u drugoj godini. Prosečno preživljavanje svih ispitanika iznosilo je 35 meseci. Ukupna smrtnost na trogodišnjem nivou iznosila je 5,3%. Zaključak. Nije bilo statistički značajne  razlike u incidenciji lokalnog recidiva i dužini preživljavanja između bolesnika kojima je urađena TME i onih kojima je urađena PME. Tip mezorektalne ekscizije ne utiče na incidenciju lokalnog recidiva  u nodus negativnim stadijumuma bolesti.

 

Reference

Krivokapic Z. Total mesorectal excision and Transection of me-sorectum. In: Krivokapic Z, editor. Rectal cancer. Belgrade: Zavod za udžbenike; 2012. p. 175−204. (Serbian)

Chandler JP, Orkin AB. Rectal carcinoma: operative treatment. In: Beck ED, Wexner DS, editors. Fundamentals of anorectal surgery. 2nd ed. London: WB Saunders Company Ltd; 1998. p. 301−54.

Kaiser AM, Kang J, Chan LS, Beart RW. The prognostic impact of the time interval to recurrence for the mortality in recurrent colorectal cancer. Colorectal Dis 2006; 8(8): 696−703.

Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Hoff PM, et al. Clinical and pathological predictors of locoregional recurrence, distant metastasis and overall survival in patients treated with chemoradiation andmesorectal excision for rectal cancer. Am J Clin Oncol 2006; 29(3): 219−24.

Jorgen F, Johansson R, Damber L, Lindmark G. Anastomotic lea-kage after surgery for rectal cancer: A risk factors for local re-currence, distant metastasis and reduced cancer-specific sur-vival. Dis Colon Rectum 2011; 54(9): e249−53.

Micev M, Popov I. Prognosis of the patients with potential cura-bile rectal cancer. Srp Arh Celok Lek 2000; 13: 1−6. (Serbian)

Manfredi S, Benhamiche AM, Meny B, Cheynel N, Rat P, Faivre J. Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer. Br J Surg 2001; 88(9): 1221−7.

Kim Y, Kim N, Min B, Huh H, Kim J, Kim J, et al. Factors asso-ciated with anastomotic recurrence after total mesorectal exci-sion in rectal cancer patients. J Surg Oncol 2009; 99(1): 58−64.

Heald RJ, Moran BJ, Brown G, Daniels IR. Optimal total meso-rectal excision for rectal cancer is by dissection in front of De-nonvilliers' fascia. Br J Surg 2004; 91(1): 121−3.

Beart RW Jr. Mesorectal excision for rectal carcinoma: The new standard. Adv Surg 1999; 32: 193−203.

Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ. To-tal mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 1995; 82(8): 1031−3.

How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R, et al. A systematic review of cancer related patient outcomes after an-terior resection and abdominoperineal excision for rectal can-cer in the total mesorectal excision era. Surg Oncol 2011; 20(4): e149−55.

Kraemer M, Wiratkapun S, Seow-Choen F, Ho YH, Eu KW, Nyam D. Stratifying risk factors for follow-up: A comparison of re-current and nonrecurrent colorectal cancer. Dis Colon Rectum 2001; 44(6): 815−21.

Sugarbaker PH, Gianola FJ, Dwyer A, Neuman NR. A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results. Surgery 1987; 102(1): 79−87.

Gagliardi G, Hawley PR, Hershman MJ, Arnott SJ. Prognostic fac-tors in surgery for local recurrence of rectal cancer. Br J Surg 1995; 82(10): 1401−5.

Michelassi F, Vannucci L, Montag A, Goldberg R, Chappell R, Dytch H, et al. Importance of tumor morphology for the long term prognosis of rectal adenocarcinoma. Am Surg 1988; 54(6): 376−9.

Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: A prospective evaluation of 622 patients. Ann Surg 2004; 240(2): 260−8.

Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision. Dis Colon Rectum 2001; 44(4): 473−83; discussion 483−6.

Lopez-Kostner F, Lavery IC, Hool GR, Rybicki LA, Fazio VW. Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery 1998; 124(4): 612−7; discussion 617−8.

van Lingen CP, Zebregts CJ, Gerritsen JJ, Mulder HJ, Mastboom WJ, Klaase JM. Local recurrence of rectal cancer after total meso-rectal excision without preoperative radiotherapy. Int J Ga-strointest Cancer 2003; 34(2−3): 129−34.

Petronella P, Scorzelli M, Manganiello A, Nunziata L, Ferretti M, Campitiello F, et al. Our experience of total mesorectal excision for rectal cancers. Hepatogastroenterology 2010; 57(99−100): 482−6.

Krivokapic Z, Barisic G, Markovic V, Popovic M, Antic S, Jovanovic D, et al. First thousand rectal cancer cases-local recurrence and survival. Acta Chir Iugosl 2004; 51(2): 133−7.

Gupta RK, Agrawal CS, Pathania OP, Bajracharya A, Sah SP, Sah PL. Anterior resection for rectal cancer with mesorectal exci-sion: Institutional review. Indian J Surg 2013; 75(1): 10−6.

Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxì A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA 2000; 284(8): 1008−15.

Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997; 336(14): 980−7.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wig-gers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345(9): 638−46.

Taylor I, van de Velde C, van Gijn W. A consensus approach to rectal cancer management. Eur J Surg Oncol 2010; 36(2): 111−3.

Objavljeno
2017/03/08
Broj časopisa
Vol. 73 Br. 10 (2016)
Rubrika
Originalni članak