Orta ve distal yerleşimli rektum kanserinde prognoza etkili faktörler
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Date
2016
Authors
Tırnova, İsmail
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Uludağ Üniversitesi Genel Cerrahi Anabilim Dalı'nda 1 Ocak 2010 ile 31 Aralık 2014 tarihleri arasında elektif ameliyata alınan ardışık 282 hasta retrospektif incelenmiştir ve operasyonda karaciğer metastazı olan, tümörü üst rektumda veya rektosigmoid bölgede olan hastalar dışlandıktan sonra kalan 158 hasta çalışmaya dahil edilmiştir. Çalışmamızda hastaların demografik ve patolojik verileri ile hastalıksız sağ kalım, sağ kalım ve lokal rekürrens parametrelerini içeren onkolojik sonuçları incelenmiştir. Çalışmamızda median yaş 60'tı (22-83). 53 hasta 65 yaş üzerindeydi (%33). Hastaların 95 tanesi erkek (%60), 63 tanesi kadındı (%40). 44 hasta ASA-I'di (%27,8). 109 hasta ASA-II iken (%70), ASA-III olan yalnızca 5 hasta vardı (%3,1). Tümör yerleşimine bakıldığında ise 80 tane orta rektum (%50,4), 78 tane distal rektum tümörü saptandı (%49,6). Tümör lokalizasyonunun onkolojik sonuçlara etkisi saptanmadı. Sirkumferensiyel rezeksiyon marjini (CRM)'nin ve distal rezeksiyon marjini (DRM)'nin hastalıksız sağ kalım, sağ kalım ve lokal rekürrens (LR) üzerine etkisi saptanmadı (p>0,05). Ancak univaryans analizlerde TME bütünlüğünün daha uzun hastalıksız sağ kalım ve sağ kalım süreleri ile ilişkili olduğu saptandı (p=0.036, p=0.048). Bunun yanında TME bütünlüğü bizim serimizde LR ile ilişkisiz bulunmuştur (p=0,882). Multivaryans analizlerde ise, TME onkolojik sonuçlar üzerine anlamlı etkisi saptanmamıştır (p>0.05). Çalışmamızda kliniğimizde rektum kanseri nedeni ile yapılan rezeksiyonlarda onkolojik sonuçlara etkili olan faktörler değerlendirilmiş ve multivaryans analizler sonucunda hastalıksız sağ kalımı etkileyen faktörler olarak abdominoperineal rezeksiyon (APR) yapılması ve perinöral invazyon saptanması, sağ kalım açısından bakıldığında ise yalnızca APR yapılması bağımsız risk faktörü olarak bulunmuştur. LR'te ise anastomoz kaçağı ve venöz-vasküler invazyon bulunması bağımsız birer risk faktörü olarak saptanmıştır.
At Surgery Department of Uludag University, between January 2010 and December 2014, 282 consecutive patients who had rectal tumors were analised retrospectively and 154 of them were included after exclusion of patients with liver metastasis, upper rectal or sigmoid tumors and transanal minimally invasive surgery. Demographic and pathological data and ongological results as disease-free survival (DFS), overall survival (OS) and local recurrence (LR) were analised. Median age was 60 (22-83). 53 patients were older then 65 year old (138). 95 patients were male (%60) and 63 of them were female (%40). 44 patients had ASA I score (%27,8). 109 patients had ASA II score (%70), while 5 other patients had ASA III score (%3,1). 80 patients had mid-rectal (%50,4), 78 patients had distal cancer (49,6). There were no effect of the tumor localisation on oncological outcomes. Circumferential resection margin (CRM) and distal resection margin (DRM) have no significant effect on oncological outcomes (p>0,05). At univariate analysis completeness of total mesorectal excision (TME) was related with longer DFS and OS (p=0,036, p=0,048). On the other hand, completeness of TME had no effect on local recurrence (p=0,882). At multivariate analysis, there were no significant effect of completeness of TME on oncological outcomes (p>0,05). In our study the factors effecting on oncological outcomes at resection of rectal carcinoma were analysed and as a result of multivariate analysis, having APR procedure and perineural invasion were detected as the independent risk factors for DFS, also, having APR was the only independent risk factor for OS. For LR, existence of anastomotic leakage and venous-vascular invasion were detected as independent risk factors.
At Surgery Department of Uludag University, between January 2010 and December 2014, 282 consecutive patients who had rectal tumors were analised retrospectively and 154 of them were included after exclusion of patients with liver metastasis, upper rectal or sigmoid tumors and transanal minimally invasive surgery. Demographic and pathological data and ongological results as disease-free survival (DFS), overall survival (OS) and local recurrence (LR) were analised. Median age was 60 (22-83). 53 patients were older then 65 year old (138). 95 patients were male (%60) and 63 of them were female (%40). 44 patients had ASA I score (%27,8). 109 patients had ASA II score (%70), while 5 other patients had ASA III score (%3,1). 80 patients had mid-rectal (%50,4), 78 patients had distal cancer (49,6). There were no effect of the tumor localisation on oncological outcomes. Circumferential resection margin (CRM) and distal resection margin (DRM) have no significant effect on oncological outcomes (p>0,05). At univariate analysis completeness of total mesorectal excision (TME) was related with longer DFS and OS (p=0,036, p=0,048). On the other hand, completeness of TME had no effect on local recurrence (p=0,882). At multivariate analysis, there were no significant effect of completeness of TME on oncological outcomes (p>0,05). In our study the factors effecting on oncological outcomes at resection of rectal carcinoma were analysed and as a result of multivariate analysis, having APR procedure and perineural invasion were detected as the independent risk factors for DFS, also, having APR was the only independent risk factor for OS. For LR, existence of anastomotic leakage and venous-vascular invasion were detected as independent risk factors.
Description
Keywords
Rektum, Kanser, Mezorektal, Rekürrens, Rectum, Cancer, Mesorectal, Recurrence
Citation
Tırnova, İ. (2016). Orta ve distal yerleşimli rektum kanserinde prognoza etkili faktörler. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.