大腸癌によるoncological emergencyと手術成績
〔要旨〕大腸癌緊急手術では救命目的に加えて，がんの根治性にも配慮する必要がある。今回，当科での大腸癌手術症例について検討した。2013〜2022年の大腸癌手術症例856例を対象とし，緊急群39例と待機群817例に群別して後方視的に検討した。緊急群はStage Ⅳが有意に多く，術式はハルトマン手術，人工肛門造設術が有意に多く，D3郭清は有意に少なかった。在院死亡率は緊急群2.6 ％で有意に高かった。術後化学療法施行率は緊急群で32.4 ％と有意に低く，Stage別の術後化学療法施行率はStageⅢで緊急群が有意に低かった。5年全生存率，5年無再発生存率ともに緊急群が有意に不良で，Stage別でみ...
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| Published in | Japanese Journal of Acute Care Surgery p. 14-16 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本Acute Care Surgery 学会
2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-102X |
| DOI | 10.50840/jjacs.14-16 |
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| Abstract | 〔要旨〕大腸癌緊急手術では救命目的に加えて，がんの根治性にも配慮する必要がある。今回，当科での大腸癌手術症例について検討した。2013〜2022年の大腸癌手術症例856例を対象とし，緊急群39例と待機群817例に群別して後方視的に検討した。緊急群はStage Ⅳが有意に多く，術式はハルトマン手術，人工肛門造設術が有意に多く，D3郭清は有意に少なかった。在院死亡率は緊急群2.6 ％で有意に高かった。術後化学療法施行率は緊急群で32.4 ％と有意に低く，Stage別の術後化学療法施行率はStageⅢで緊急群が有意に低かった。5年全生存率，5年無再発生存率ともに緊急群が有意に不良で，Stage別でみるとStageⅢで緊急群が有意に不良であり，再発形式は腹膜播種が多かった。大腸癌緊急手術における短期予後は比較的良好だったが，さらに長期予後の改善のためには患者状態を考慮したうえでの適切な術式選択や術後化学療法が有用となる可能性がある。 |
|---|---|
| AbstractList | 〔要旨〕大腸癌緊急手術では救命目的に加えて，がんの根治性にも配慮する必要がある。今回，当科での大腸癌手術症例について検討した。2013〜2022年の大腸癌手術症例856例を対象とし，緊急群39例と待機群817例に群別して後方視的に検討した。緊急群はStage Ⅳが有意に多く，術式はハルトマン手術，人工肛門造設術が有意に多く，D3郭清は有意に少なかった。在院死亡率は緊急群2.6 ％で有意に高かった。術後化学療法施行率は緊急群で32.4 ％と有意に低く，Stage別の術後化学療法施行率はStageⅢで緊急群が有意に低かった。5年全生存率，5年無再発生存率ともに緊急群が有意に不良で，Stage別でみるとStageⅢで緊急群が有意に不良であり，再発形式は腹膜播種が多かった。大腸癌緊急手術における短期予後は比較的良好だったが，さらに長期予後の改善のためには患者状態を考慮したうえでの適切な術式選択や術後化学療法が有用となる可能性がある。 |
| Author | 川口, 雄太 曽山, 明彦 足立, 利幸 小林, 和真 江口, 晋 足立, 智彦 金高, 賢悟 井上, 悠介 三好, 敬之 岡田, 怜美 |
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| References | 21）Norwood MG, Sutton AJ, West K, et al: Lymph node retrieval in colorectal cancer resection specimens: national standards are achievable, and low numbers are associated with reduced survival. Colorectal Dis 2010; 12: 304-309. 3）Mojtaba A, Seyyed MP, Fatemeh B, et al: Surgical outcome and clinicopathological characteristics of emergency presentation elective cases of colorectal cancer. Arch Med Sci 2018; 14: 826-829. 6）McArdle CS, Anderson JH: Obstructing large bowel cancer. In: Colorectal Cancer. McArdle CS, Kerr DJ, Boyle P （eds）. Isis Medical Media, Oxford 2000; 195-207. 18）白坂健太郎，船橋公彦，小池淳一，他：穿孔が大腸癌患者の予後に与える影響．日消外会誌 2004；40：1881-1886. 1）Tan E, Tilney H, Thompson M, et al: The United Kingdom National Bowel Cancer Project-epidemiology and surgical risk in the elderly. Eur J Cancer 2007; 43: 2285-2294. 7）Carraro PG, Segala M, Cesana BM, et al: Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 2001; 44: 243-250. 27）Charlson ME, Pompei P, Ales KL, et al: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383. 26）Weixler B, Warschkow R, Ramser M, et al: Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 2016; 16: 208. 5）Alvarez JA, Baldonedo RF, Bear IG, et al: Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005; 190: 376-382. 25）Chiarugi M, Galatioto C, Panicucci S, et al: Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol 2007; 16: S73-S77. 12）Wong SKC, Jalaludin BB, Morgan MJ, et al.: Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 2008; 51: 223-230. 20）Tobaruela E, Camuñas J, Enríquez-Navascúes JM, et al: Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 1997; 89: 13-22. 15）Kumar S, Kafle P, Patowary BN, et al: Surgical outcome and clinical profile of emergency versus elective cases of colorectal cancer in College of Medical Sciences, Nepal. Journal of College of Medical Sciences-Nepal 2013; 9: 25-30. 22）Le Voyer TE, Sigurdson ER, Hanlon AL, et al: Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003; 21: 2912-2919. 35）Merkow RP, Bentrem DJ, Mulcahy MF, et al: Effect of postoperative complications on adjuvant chemo- therapy use for stage III colon cancer. Ann Surg 2013; 258: 847-853. 17）Traiki TAB, AlShammari SA, AlRabah RN, et al: Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience. Saudi J Gastroenterol 2023; 29: 316-322. 33）Lavanchy JL, Vaisnora L, Haltmeier T, et al: Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis 2019; 34: 2091-2099. 11）Zhou H, Jin Y, Wang J, et al: Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38: 41. 19）Sjo OH, Larsen S, Lunde OC, et al: Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 2009; 11: 733-739. 23）Xu Z, Becerra AZ, Aquina CT, et al: Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 2017; 21: 543-553. 28）Glynne-Jones R, Wyrwicz L, Tiret E, et al: Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28: iv22-iv40. 8）McArdle CS, Hole DJ: Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 2004; 91: 605-609. 16）Ascanelli S, Navarra G, Tonini G, et al: Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori Journal 2003; 89: 36-41. 29）澁谷雅常，寺岡均，中尾重富，他：大腸癌穿孔症例の臨床的検討．日臨外会誌 2009；70：2276-2280. 10）Talebreza A, Yahaghi E, Bolvardi E, et al: Investigation of clinicopathological parameters in emergency colorectal cancer surgery: a study of 67 patients. Arch Med Sci 2017; 6: 1394-1398. 37）Lee WS, Baek JH, You DH, et al: Prognostic value of circulating cytokines for stage III colon cancer. J Surg Res 2013; 182: 49-54. 14）Bass G, Fleming C, Conneely J, et al: Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum 2009; 52: 678-668. 31）Anderson J H, Hole D, McArdle CS: Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 1992; 79: 706-709. 9）Ghazi S, Berg E, Lindblom A, et al: Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 2013; 11: 133. 34）Hendren S, Birkmeyer JD, Yin H, et al: Surgical complications are associated with omission of chemotherapy for stage III colorectal cancer. Dis Colon Rectum 2010; 53: 1587-1593. 30）日高秀樹，佛坂正幸，千々岩一男，他：大腸穿孔例の予後因子の検討．日本大腸肛門病会誌2006；59：54-58. 32）Amri R, Bordeianou LG, Sylla P, et al: Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 2015; 209: 246-253. 2）Ries LAG, Eisner MP: SEER Cancer Statistics Review, 1973-1997. Bethesda, MD: National Cancer Institute 2000. 13）Metcalfe MS, Norwood MGA, Miller AS, et al: Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis 2005; 7: 275-278. 36）Okamura A, Takeuchi H, Matsuda S, et al: Factors affecting cytokine change after esophagectomy for esophageal cancer. Ann Surg Oncol 2015; 22: 3130-3135. 24）Coco C, Verbo A, Manno A, et al: Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 2005; 29: 1458-1464. 4）Brown SC, Abraham JS, Walsh S, et al: Risk factors and operative mortality in surgery for colorectal cancer. Ann R Coll Surg Engl 1991; 73: 269-272. |
| References_xml | – reference: 22）Le Voyer TE, Sigurdson ER, Hanlon AL, et al: Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003; 21: 2912-2919. – reference: 29）澁谷雅常，寺岡均，中尾重富，他：大腸癌穿孔症例の臨床的検討．日臨外会誌 2009；70：2276-2280. – reference: 2）Ries LAG, Eisner MP: SEER Cancer Statistics Review, 1973-1997. Bethesda, MD: National Cancer Institute 2000. – reference: 15）Kumar S, Kafle P, Patowary BN, et al: Surgical outcome and clinical profile of emergency versus elective cases of colorectal cancer in College of Medical Sciences, Nepal. Journal of College of Medical Sciences-Nepal 2013; 9: 25-30. – reference: 4）Brown SC, Abraham JS, Walsh S, et al: Risk factors and operative mortality in surgery for colorectal cancer. Ann R Coll Surg Engl 1991; 73: 269-272. – reference: 18）白坂健太郎，船橋公彦，小池淳一，他：穿孔が大腸癌患者の予後に与える影響．日消外会誌 2004；40：1881-1886. – reference: 3）Mojtaba A, Seyyed MP, Fatemeh B, et al: Surgical outcome and clinicopathological characteristics of emergency presentation elective cases of colorectal cancer. Arch Med Sci 2018; 14: 826-829. – reference: 23）Xu Z, Becerra AZ, Aquina CT, et al: Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 2017; 21: 543-553. – reference: 33）Lavanchy JL, Vaisnora L, Haltmeier T, et al: Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis 2019; 34: 2091-2099. – reference: 24）Coco C, Verbo A, Manno A, et al: Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 2005; 29: 1458-1464. – reference: 32）Amri R, Bordeianou LG, Sylla P, et al: Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 2015; 209: 246-253. – reference: 34）Hendren S, Birkmeyer JD, Yin H, et al: Surgical complications are associated with omission of chemotherapy for stage III colorectal cancer. Dis Colon Rectum 2010; 53: 1587-1593. – reference: 30）日高秀樹，佛坂正幸，千々岩一男，他：大腸穿孔例の予後因子の検討．日本大腸肛門病会誌2006；59：54-58. – reference: 31）Anderson J H, Hole D, McArdle CS: Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 1992; 79: 706-709. – reference: 21）Norwood MG, Sutton AJ, West K, et al: Lymph node retrieval in colorectal cancer resection specimens: national standards are achievable, and low numbers are associated with reduced survival. Colorectal Dis 2010; 12: 304-309. – reference: 8）McArdle CS, Hole DJ: Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 2004; 91: 605-609. – reference: 14）Bass G, Fleming C, Conneely J, et al: Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum 2009; 52: 678-668. – reference: 10）Talebreza A, Yahaghi E, Bolvardi E, et al: Investigation of clinicopathological parameters in emergency colorectal cancer surgery: a study of 67 patients. Arch Med Sci 2017; 6: 1394-1398. – reference: 37）Lee WS, Baek JH, You DH, et al: Prognostic value of circulating cytokines for stage III colon cancer. J Surg Res 2013; 182: 49-54. – reference: 27）Charlson ME, Pompei P, Ales KL, et al: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383. – reference: 11）Zhou H, Jin Y, Wang J, et al: Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38: 41. – reference: 36）Okamura A, Takeuchi H, Matsuda S, et al: Factors affecting cytokine change after esophagectomy for esophageal cancer. Ann Surg Oncol 2015; 22: 3130-3135. – reference: 12）Wong SKC, Jalaludin BB, Morgan MJ, et al.: Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 2008; 51: 223-230. – reference: 25）Chiarugi M, Galatioto C, Panicucci S, et al: Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol 2007; 16: S73-S77. – reference: 6）McArdle CS, Anderson JH: Obstructing large bowel cancer. In: Colorectal Cancer. McArdle CS, Kerr DJ, Boyle P （eds）. Isis Medical Media, Oxford 2000; 195-207. – reference: 9）Ghazi S, Berg E, Lindblom A, et al: Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 2013; 11: 133. – reference: 17）Traiki TAB, AlShammari SA, AlRabah RN, et al: Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience. Saudi J Gastroenterol 2023; 29: 316-322. – reference: 19）Sjo OH, Larsen S, Lunde OC, et al: Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 2009; 11: 733-739. – reference: 20）Tobaruela E, Camuñas J, Enríquez-Navascúes JM, et al: Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 1997; 89: 13-22. – reference: 26）Weixler B, Warschkow R, Ramser M, et al: Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 2016; 16: 208. – reference: 13）Metcalfe MS, Norwood MGA, Miller AS, et al: Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis 2005; 7: 275-278. – reference: 16）Ascanelli S, Navarra G, Tonini G, et al: Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori Journal 2003; 89: 36-41. – reference: 1）Tan E, Tilney H, Thompson M, et al: The United Kingdom National Bowel Cancer Project-epidemiology and surgical risk in the elderly. Eur J Cancer 2007; 43: 2285-2294. – reference: 28）Glynne-Jones R, Wyrwicz L, Tiret E, et al: Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28: iv22-iv40. – reference: 35）Merkow RP, Bentrem DJ, Mulcahy MF, et al: Effect of postoperative complications on adjuvant chemo- therapy use for stage III colon cancer. Ann Surg 2013; 258: 847-853. – reference: 7）Carraro PG, Segala M, Cesana BM, et al: Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 2001; 44: 243-250. – reference: 5）Alvarez JA, Baldonedo RF, Bear IG, et al: Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005; 190: 376-382. |
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