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대장 및 직장암 1,037예에 대한 후향적 임상 분석

A Clinical Study of 1,037 Cases of Colorectal Cancer

대한대장항문학회지 1996년 12권 1호 p.77 ~ 88
이태일 ( Lee Tae-Il ) - 삼성의료원

김흥대 ( Kim Heung-Dae ) - 삼성의료원
한원곤 ( Han Won-Gone ) - 삼성의료원
배원길 ( Bae Won-Gil ) - 삼성의료원
김광연 ( Kim Kwang-Youn ) - 삼성의료원

Abstract


This report is a retrospective clinical analysis of 1,037 cases of colorectal carcinoma treated surgically by the Department of Surgery of Kangbuk Samsung Hospital from January 1969 to October 1994. The results were as follows; 1) The ratio between male and female was 1.45: 1; peak age incidence was the 5th decade; there were 293 cases(28.2%, M: F= 168: 125). 2) Comparing yearly incidence of cancer, 72 cases in 1970∼1974, 98 cases in 1975∼ 1979, 151 cases in 1980∼1984, 229 cases in 1985∼1989, 487 cases in 1990∼1994, and the incidence of carcinoma is increasing steadily. 3) The rectum involved 676 cases(65.2%), sigmoid colon 118 cases(11.3%), and hepatic flexure 66 cases(6.3%). The rectum and sigmoid colon were most common. 4) The symptoms and signs in all cases of colorectal cancer were tenesmus(65.4%),
bloody stool(62.9%), abdominal pain(49.3%), bowel habit change(44.2%), weight loss(36.6%), constipation(36.2%). In rectosigmoid cancer, tenesmus(83.1%), bloody stool(75.8%) and bowel habit change(39.4%). 5) In modified Dukes’ classification, C2 was most common in 365 cases(37.9%), B2 in 232 cases(24.1%), D in 140 cases(14.5%), Bl in 121 cases(12.5%),4 in 63 cases(6.5%) and Cl in 42 cases(4.3% ). 6) In the histopathological classification, adenocarcinoma was most common in 984 cases(94.8% ), carcinoid tumor in 19 cases, malignant lymphoma in 15 cases, squamous
cell carcinoma in 11 cases and leiomyosarcoma in 8 cases. 7) In the decree of cell differentiation, moderately differentiated carcinoma were 451 cases(45.8%), well-differentiated carcinoma in 307 cases(31.1%), poorly differentiated
carcinoma in 173 cases(17.6%) and mucinous type in 53 cases(5.38%). 8) Preoperative CEA was checked in 613 cases(59.1%). CEA was less than 5 ng/ml in 268 cases(43.7%), 5∼ 10 ng/ml in 142 cases(23.2%) and more than 10 ng/ml in 203
cases(33.1%). 9) Regarding operative method, Mile’s operation in 316 cases(32.8%), low anterior resection in 196 cases(20.3%), anterior resection in 126 cases(13.1%), right hemicolectomy in 138 cases(14.3%) and others including left hemicolectomy, Pull-through operation, Hartmann operation and Mason operation were performed. 10) Distant metastasis and recurrence were discovered in 344 cases overall : (1) 157 cases(45.6%) in the synchronous type: hepatic metastasis in 103 cases(65.6%), peritoneal metastasis in 33 cases(21.0%) and pulmonary metastasis in 13 case(8.28%). (2) 187
cases(54.4%) in the metachronous type: hepatic metastasis in 40 cases(21.4%), lymphatic metastasis in 37 cases(19.8%), pulmonary metastasis in 35 cases(18.7%), recurrence at anastomosis site in 32 cases(17.1%) and peritoneal metastasis in 6 cases(3.21%). 11) Regarding treatment, operations were performed in 963 cases(92.8%) overall ; surgery and adjutant chemotherapy were performed in 594 cases(57.3%); surgery only in 258 cases(24.9%); surgery, irradiation and chemotherapy in 78 cases(7.52%); surgery and irradiation in 33 cases(3.18%). In the recurrence of tumor, chemotherapy was performed in 47 cases(25.1%), curative .surgery in 38 cases(20.3%), radiotherapy without any other treatment in 13 cases(6.96%), but no other treatment was performed in 78 cases(41.7%). 12) In comparing the 5 year survival rate according to modified Dukes’ classification, Dukes’ A 92.0%, Bl 88.3%, B2 73.1%, and Cl 56.2%, C2 37.7%, D 9.4% and overall 51.8% (P<0.05).

키워드

Colorectal Neoplasms
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