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폐쇄성 대장암의 치료

Treatment of Obstructive Colorectal Cancer

대한대장항문학회지 1998년 14권 4호 p.751 ~ 760
이동희 ( Lee Dong-Hee ) - 울산대학교 의과대학 서울중앙병원 외과학교실 대장항문클리닉

이인택 ( Lee In-Teak ) - 울산대학교 의과대학 서울중앙병원 외과학교실
정봉수 ( Jung Bong-Soo ) - 안동종합병원 일반외과
정춘식 ( Jung Chun-Sik ) - 울산대학교 의과대학 서울중앙병원 외과학교실
김창남 ( Kim Chang-Nam ) - 울산대학교 의과대학 서울중앙병원 외과학교실
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 서울중앙병원 외과학교실 대장항문클리닉
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 서울아산병원 외과학교실

Abstract


The occurrence of the colonic obstruction secondary to colorectal carcinoma (CRC) has been reported in 7∼30% of the CRC patients. It is generally believed that obstructive CRC is associated with a poor prognosis with respect to operative mortality and five-year survival. A series of 1064 cases of the CRC treated surgically at Asan Medical Center from June 1989 to December 1996 has been analyzed to compare clinicopathological findings between obstructive and non-obstructive CRC and to evaluate surgical treatment options in obstructive CRC. Complete obstruction was present in 49 cases (4.6%). There were no differences between obstructive and non-obstructive CRC in tumor location, size, Dukes’ stage, and differentiation. In forty-nine obstructive CRC cases, primary resections were performed in 29 cases after peri-operative bowel decompression. In this group, right colon cancer was more prevalent than staged operation group (45% vs. 5%, P<0.05) and hospital stay was significantly short (16 days vs. 38 days, P<0.05). Postoperative complication rate was higher in staged operation group (65% vs. 28%, P=0.01). It may be due to stoma related wound complication. In obstructive left colon cancer, there was a significant difference in complication rate between primary resection and staged operation (P<0.05). Overall 5-year survival rate were 66% and 53% in non-obstructive and obstructive group, respectively. Survival rate according to the Dukes’ B and C stages did not show statistical differences, either. Conclusively, primary resection is preferred to the obstructive CRC when supportive care, preoperative bowel decompression, and intraoperative colonic irrigation were performed adequately.

키워드

Obstructive colorectal cancer;Primary resection
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