教室における大腸癌症例の検討-第二報 ： 手術成績および遠隔治療成績

Abstract

During the 18-year period from 1972 through 1990, 498 patients were admitted to our clinic for colorectal cancer. Dividing the patients into two groups (one included the cases of the first 10-year period which were mainly operated with "R2" lymphnode cleaning, and the another included cases of the latter 8 years with "R3" lymphnode cleaning), we evaluated the variation of the outcome of surgical treatment comparing the results of the two periods. The results were as follows : 1. The resection rates were elevated in both colonic and rectal cancer (82.5% to 98.6% and 89.5% to 95.8%, respectively). The curative resection rates also increased (colon : from 56.3% to 77.3%, rectum : from 74.6% to 86.6%) 2. The surgical mortality rates decreased from 2.6% to 0.8%. 3. Noncurative resections were caused by hepatic metastasis (61%), peritoneal dissemination (26%), distant metastasis excluding the liver (11.8%), locally far advanced extension (11.8%) and exceeding spread of lymphnode metastasis (10.5%) 4. The overall 5-year survival rates increased in colonic and rectal cancer (52.5% to 64.3% and 40.8% to 67.3%, respectively), and also improved with regard to curatively operated cases (73.4% to 78.6% and 54.5% to 81.9%, respectively). The survival rates by Dukes' classification revealed improvement in Dukes B and C of rectal cancer cases. According to stage classification, stage Ⅲ and Ⅳ had changes for the better. 5. Recurrences of curatively resected cases occurred in 83.3% within 2 years after primary operations, but no reccurrence was recognized in those cases after 5 years. 6. The incidence of sphincter saving operations for lower rectal cancer ("Ra-Rb") was elevated from 11.4% to 35.1%. The survival rates showed no significant difference between sphincter saving operation and abdominoperoneal resection in both periods.