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직장암에 대한 국소절제술

Local Excision for Rectal Cancer

대한대장항문학회지 2002년 18권 5호 p.305 ~ 310
남궁환 ( Namgung Hwan ) - 울산대학교 의과대학 외과학교실

유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
조영규 ( Cho Young-Kyu ) - 울산대학교 의과대학 외과학교실
유장학 ( Yoo Jang-Hak ) - 울산대학교 의과대학 외과학교실
조문경 ( Jo Moon-Kyung ) - 울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실

Abstract


Purpose: Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological outcomes after local excision for rectal cancers.

Methods: We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58±11 years and median follow up period was 24 (range: 1∼82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%).

Results: The distance from the anal verge was 5.9±2.6 ㎝ and the mean tumor size was 2.5±2.0 ㎝. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73%
and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection.

Conclusion: Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.

키워드

국소절제술;직장암
Local excision;Rectal cancer
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