Clinical And Basic Study Of Reoperation Of Recurrent Colorectal Cancer

The incidence of colorectal carcinoma has been growing up with theyears and it has become one of the most common malignant neoplasmwbich are threatening human heing's health seriously all. Althougha lot of patients can be treated with surgical operation, the five-yearsurvival rate is less than 50%. The main cause of treatment failure islocal recurrence and far away metastasis. In order to study the causesof recurrence after operation, we studied l36 patients with recurrentcoIorectal carcinoma after curative resection of primary colorectalcarcinoma. To the recurrent colorectal carcinoma, we recommendreoperation. With preoperative intra-artery chemotherapy,radiotherapy, immunotherapy and some other adjuvant methods,84.5% of tbe recurrent tumors were resected. Among them 92.2%patients underwent radicaI resection. The five year survival rata is44.8% for those with radical resection and 40.6% for those withpalliative resection. We find that Iocal recurrence after the primaryresection was closely related to extra intestinal soft tissue infiltration,inappropriate surgery and residual infiltrated lymph nodes.(1) Thmor recurrence i8 related to extra inte8tinal 8of t ti8sueinfiltration and unthorough lymph node cIearing. LocaI recurrencemostly takes place at the perineum and peIvic cavity In our group,recurrence mostIy t8ke place at pelvic connective tissue andanastomotic site after Dixon' 8 surgery or the intestinaI tract itseIfafter pull-out surgery. Secondly is tbe lymph node8 and perineum. Wethink the main cause i8 unthorough local and lymph node excision.We recommend that radicaI treatment should incIude ablation ofprimary site, connecting normal intestinal tract and connective tissuearound and clearing alI the regurgitating Iymph node8. With theemergence of the rectal stapIer, some doctors prefer Dixon's 8urgeryand neglect the importance of radical re8ection. So recurrence at theanastomotic site has grown up 8oundly.(2) Recurrence i8 reIated tO inappropriate surgerp We tbink themas8 type, innltration 8t8ge, histological type and .lymph nodemetastasi8 should be taken intO thought befOre 8electing appropriatesurgery Radical surgery i8 of first choice and then is the functional.@TO the rectaI infiltrative myxoadenocarcinoma and Dukes Ccarcinoma, large excision is preferred and anus preserving surgery isnot suitabIe. @ TO the rect8I carcinoma with vaginaI post6riorinfiItration, vaginal posterior ablation is insufficient and ovarianshouId be excised with vaginaI post6rior because they beIong tO the5ame Iymph node regurgitation system. 1f the patient is older than 45,bilateral ovariectomy is needed. @ TO tho8e with prost8t6sinfi1tration, aIl the organs within the pelvic cavity need to be excisedlut it only suits appropriate patients. @ TO those with one side.rinary duct infiltration, if the function of the oppo8it6 Iddney is good,igate the urinary duct at the upper site and cut off it, don' t try tOixcoriate it because that may injure it or even cause it to necrosis.(3) In the past, many patient8 with recurrent colorectalcarcinoma were treat6d only with palliative method includingchemotberaPy radiotherapy and sympotomatic treatment. Manypatients will die in a short period. Reoperation wilI eIongat6 the lifegpectancy obviously We feel: to avoid locaI recurrence of rectalama8tomosi8 after Dixon's surgery we 8hould choose Mile' 8 surgery;As fOr the pelvic recurrence after MiIe's surgery, we can choosereoperation u8ing Mile' 8 method. Preoperative radiotheraPy andsometime8 radiotheraPy through surgery have cert8in benefit. Inoperation, we 8hould O befOre excising the tumoI', ligat6 bilateralinterual iIiac arteries to Iessen bleeding, @ excorticate bilateralurinary duct8 carefully or they may be damaged, @ if the venousplexus of sacralia anteriona break and bIeed, the best way is tO pre8sthe bleeding 8ite witk gauze sponges. @ After ablation of tk...