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摘要


背景神經內分泌腫瘤,或稱類癌,為第二常見之大腸直腸惡性腫瘤。由於大腸鏡篩檢之普及,此腫瘤的發生率也隨之提高。根據腫瘤表現可分為低惡性(低分化)及高惡性(高分化)。本篇研究之目的為大腸直腸神經內分泌瘤之治療成果及預後分析。方法本篇研究收集2005年至2014年六十位大腸直腸神經內分泌瘤患者進行回溯性研究分析。針對腫瘤直徑較小者(<2公分),本研究比較由內視鏡切除及經肛門手術切除之完全切除率、併發症發生率及存活率。針對腫瘤直徑較大(>2公分)或侵犯範圍較大者,本研究比較手術與非手術治療之併發症發生率、死亡率及整體存活率。結果六十位大腸直腸神經內分泌瘤患者中,有十位病患因資訊不足或未回診追蹤而排除。十九位病患接受內視鏡切除、十一位病患接受及經肛門手術切除。兩者之完全切除率無明顯差異,且在追蹤過程中並未發現腫瘤復發。十一位病患接受部分大腸切除及廣泛性淋巴廓清手術。四位病患手術前已發現遠端轉移而其中兩位在一年內死亡。七位手術前未發現遠端轉移之病患中有四位在術後追蹤過程中發現遠端轉移,然而僅一位病患在一年內死亡。九位病患接受非手術治療,皆因一開始即發現遠端轉移,其中五位在一年內死亡。在一開始即發現遠端轉移之病患中,手術與非手術在整體存活率無顯著差異。結論直徑較小之大腸直腸神經內分泌瘤預後良好,以內視鏡切除及經肛門手術切除知預後無明顯差異。直徑較大或高惡性腫瘤者,手術治療成果佳但仍有相對高風險發生遠端轉移。在一開始即發現遠端轉移之病患中,手術與非手術在整體存活率無顯著差異。

關鍵字

大腸 直腸 神經內分泌瘤 手術

並列摘要


Background. Neuroendocrine tumors, previously known as carcinoid tumors, are the second most common malignancy in the colon and rectum. Their incidence is gradually increasing due to progressively advanced screening tools and spreading awareness of the detection of adenocarcinomas. Neuroendocrine tumors are classified according to their behavior as low (well-differentiated) and high (poorly-differentiated) grade. We analyzed the treatment outcome of colorectal neuroendocrine tumor. Methods. We retrospectively reviewed 60 patients who were diagnosed with colorectal neuroendocrine tumor between May 2005 and December 2014. The distribution of the tumor location was evaluated. For smaller tumors (< 2 cm), we compared the complete resection rate, complication rate, and oncologic outcome between transanal tumor resection and endoscopic submucosal dissection. For larger tumors (> 2 cm) or advanced disease, we analyzed the surgical morbidity, mortality, and overall survival rates as compared to nonsurgery patients. Results. Out of 60 colorectal neuroendocrine tumor patients, 10 were excluded due to incomplete information or loss of follow-up. A total of 19 patients underwent endoscopic resection and 11 underwent transanal excision of the tumor. There was no significant difference in the complete resection rate between the endoscopic and transanal groups. None of those patients had recurrent tumor during follow-up. Among 11 patients who underwent radical colectomy and lymph node dissection, 4 had distant metastasis initially and 2 (50%) died within 1 year. Of the other 7 patients without distant metastasis initially, 4 (57%) eventually had distant metastasis but only 1 (14%) died within 1 year. Of 9 patients who didnot undergo surgical treatment (all 9 had initial liver metastasis), 5 (56%) died within 1 year. There was no significant difference in overall survival between the surgery and nonsurgery groups among patients with distant metastasis. Conclusion. Small colorectal neuroendocrine tumors have a good prognosis, with no significant difference in outcome when treated by colonoscopic removal or transanal resection. For larger or high grade neuroendocrine tumors, radical surgery provided acceptable survival despite having a high risk of distant metastasis. For patients with initial stage IV disease, the 1-year survival rate was relatively low and there was no difference in outcome between the surgery and nonsurgery groups.

並列關鍵字

Colon Rectum Neuroendocrine tumor Surgery

參考文獻


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