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題名:Transanal Local Excision of Rectal Malignant Neoplasms    
著者:Wai-Hung Leung(梁偉雄) ;Ming-Jen Chen(陳明仁)
關鍵字:局部切除術 ; 直腸癌 ; 復發率 ; local excision ; rectal cancers ; recurrence
刊名:Journal of the Chinese Oncology Society
摘要: 中文摘要PDF ; 英文摘要PDF

背景:局部切除術已被接受於直腸腫瘤以症狀治療為原則之支持療法,其優點是:併發症少、恢復快及可保存肛門。許多文獻報告其存活率不下於根除手術,但其有較高之局部再發率,因此若應用於早期直腸癌之治療仍有爭議。 方法:從1992年6月至2006年4月,我們其收集了十四個病例,從病歷回顧分析其不願接受根除手術之原因、手術中之細節、存活率及結果;亦會回顧各個病理報告並分析之。 結果:接受局部切除手術之原因為拒絕根除性手術、堅絕保留肛門、病患有較高之手術及麻醉風險及已發生多處轉移。麻醉方式為局部麻醉或配合經靜脈投予鎮靜劑,術中出血甚少,無術中或術後之併發症產生。排除已有遠端轉移之病患後其三年總存活率為85.7%,扣除非癌症死因後之三年存活率則提升至100%,其中兩例存活超過十年;復發率為33.3%。 結論:局部切除術可為根除手術外治療低風險早期直腸癌之另一選擇,因其有可接受之存活率,但卻有較高之復發率,但我們認為局部切除術只應保留予不合適或不願意接受根除手術之病人及末期病患之症狀治療。
Background: Local excision (LE) is accepted as palliative treatment for rectal cancer. Advantages of LE include low morbidity, early recovery and preservation of the anus. Many series reporting on LE in early rectal cancer (T1 and T2 lesions) have shown a comparable long-term survival when compared with radical resection (RR); however, its curative role in early rectal cancer remains controversial due to a higher local recurrence rate. Methods: This is a retrospective study which included thirteen patients with rectal malignacies who received transanal LE from June, 1992 to April, 2006. Medical records were reviewed for the reasons of LE, details of operations, outcomes and survival. Pathologic reports were also reviewed and analyzed. Results: The reasons for LE were refusal of RR, insistence on anus preservation, high surgical and anesthetic risks of major surgery and unresectable distant metastases. All procedures were performed under local anesthesia with or without intravenous sedation and operative blood losses were negligible. No intraoperative and perioperative complication occurred in our series. Excluding the patients with synchronous distant metastases, the overall and cancer-specific 3-year survivals for early rectal cancer were 85.7% and 100% respectively. Survival for more than 10 years was also noted in our series. Overall recurrence rate was 33.3%. Conclusions: LE may be an alternative of RR for low risk early rectal cancer with acceptable long-term survival, but the local recurrence rate is higher than that of RR. In our opinion, LE should be reserved only for those patients who are not suitable for or unwilling to undergo RR, strong intent of sphincter preservation and symptomatic patients with unresectable distant metastases.


Journal of the Chinese Oncology Society
Treatment Outcome in Oropharyngeal Carcinoma-Preliminary Report/ Chih-Yung YangYi-Shing LeuJehn-Chuan LeeYi-Fang ChangMin-Jer HuangYu-Jen ChenHong-Wen ChenHung-Tao HsiaoChung-Ji Liu
Carcinoid Tumors of the Appendix-Experience in a Teaching Hospital/ Jiunn-Chang LinTsang-Pai LiuJee-Jen LeeChien-Liang LiuTsen-Long Yang
Transanal Local Excision of Rectal Malignant Neoplasms/ Wai-Hung LeungMing-Jen Chen
Local Anesthesia to Improve Postoperative Outcome for Breast Cancer Surgery: Preliminary Results/ Chung-Hsin TsaiYung-Wei HsuShih-Ping ChengChien-Liang LiuTsen-Long YangChun-Yueh LinYuan-Ching Chang
電腦刀立體定位放射性手術於治療第一型及第二型聽神經腫瘤之研究/ 林乾閔蔡若婷林牧熹林家瑋蘇鈺凱柯宗伯魏立邱文達張丞圭葉宜憲
家族性甲狀腺癌/ 鄭世平楊圳隆鄭國祥劉建良李居仁劉滄柏
影響臺灣地區非安寧照顧下進展性癌症病患認知預後的因素/ 陳貞秀劉莉妮徐翠霞蔣曉文雷靜怡唐秀治
原發性膽囊癌的臨床分析/ 陳志仁王蒼恩張文熊林錫泉白明忠李晉賢
A Case of Gastrointestinal Stromal Tumor (GIST) of Jejunum Presenting as Hollow Organ Perforation/ Shu-Hong ChuangHung-Bun LamChien-Liang Liu
A Disappearing Splenic Tumor on CT and MRI-A Case Report of Splenic Hamartoma/ Ming-Feng TsaiFei-Shih YangTsang-Pai LiuBe-Fong ChenTsang-En WangChien-Liang Liu

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