Advanced Colorectal Cancer 嘉義長庚醫院 大腸直腸外科 葉重宏

大腸直腸癌發生率 十萬人口發生率 美國 紐約 31.0 日本人 30.8 中國人 31.3 台灣 19.0 新加坡 中國人 15.9 香港 12.5 大陸、上海 7.6 菲律賓 4.1 印度 1.8 一生中得大腸直腸癌機會 6% ，如果有家族史則 機會上升。

發 生 率 ( 1996 ) 男 性 女 性 肝 癌 子 宮 頸 癌 肺癌 乳癌 大 腸 直 腸 癌 大 腸 直 腸 癌 ( ) ( ) 5252 ( ) 大腸直腸癌的台灣現況 ( 一 )

大腸直腸癌的台灣現況 ( 二 ) 致死率 ( 1999 ) 全民 男 性 女 性 肺 癌 肝 癌 肺 癌 肝 癌 肺 癌 肝 癌 大 腸 直 腸 癌 大 腸 直 腸 癌 大 腸 直 腸 癌 ( ) ( ) ( )

Complicated Carcinoma Synchronous polyps and / or Carcinoma Obstruction Perforation Bleeding Invasion of Adjacent viscera

Invasion to Adjacent Viscera Abdominal wall Small bowel Urinary bladder Uterus Stomach Spleen Ureter Duodenum Another segment of colon

Incidence (1) 6 % ~ 12 % of all patients with colon Carcinoma without distal metastasis invaded adjacent viscera

Incidence (2) Gall, Tonak, and altendorf – cases for curative resection for Colorectal CA 121 cases ( 6.3 % ) with multi-visceral involvement Uterus 39 % Small bowel 21 % Urinary bladder 16 % Abdominal wall 4 %

Character of invasion (1) Sometimes these adhesion is caused by inflammation not by malignant infiltration  The prognosis might be better than originally anticipated

Character of invasion (2) No. of Adhesions (%) Authors patients Carcinomatous Inflammatory McGlone et al Pittam et al Eldar et al Glass et al Gall et al Hunter et al Eisenberg et al Montesani et al Curley et al Izbicki et al

Principle of treatment (1) En bloc resection Conservative treatment for : Duodenum Bladder base Morbidity and mortality vs. benefit from radical resection

Principle of treatment (2) Curley et al. – cases extended R ’ t hemicolectomy and pancreaticoduodenectomy No mortality was noted Talamonti et al. – cases AR + total cystectomy 34 cases AR + partial cystectomy Mortality 3/36 and 0/34 5-year survival rate 52 %

Principle of treatment (3) Gall et al. – year survival rate with en bloc resection : 49 % ~ 54 % Inadvertently torn or transected the invasion : 17 %

Principle of treatment (4) Hunter et al. – 1987 standard en bloc colectomy colectomy resection with seperation 5-year Survival 55 % 61 % 23 % Recurrence 33 % 36 % 77 % Local recurrence 11 % 18 % 69 %

Operative mortality Gall et al. (1987 ) 12 % Hunter et al. (1987) 0 % Pittam et al. (1984) 14 % Lopez et al. (1993) 6 % Montesani et al. (1991) 0 %

Operative Morbidity Kroneman et al (1991) 6 % Landercasper et al. (1992) 24% Lopez et al.( 1993) 7 %

5-year survival rate McGlone et al. ( 1982 ) 79% Eldar et al. ( 1985 ) 35% Glass et al. ( 1986 ) 70% Gall et al. ( 1987 ) 52% Montesani et al. ( 1991 ) 30% Curley et al. ( 1992 ) 54%

Summary Fair prognosis in some cases Improved morbidity rate Decrease mortality rate Improve 5-year survival rate after en bloc resection  Encourage : En bloc resection

Thank You