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술 전 방사선 치료를 받은 직장암 환자에서 수술 중 간 전이의 발견

Intraoperative Detection of Liver Metastasis after Preoperative Radiotherapy in Rectal Cancer

대한대장항문학회지 2002년 18권 6호 p.415 ~ 418
이승현 ( Lee Seung-Hyun ) - 고신대학교 복음병원 외과학교실

안병권 ( Ahn Byung-Keon ) - 고신대학교 복음병원 외과학교실
백승언 ( Baek Sung-Uhn ) - 고신대학교 복음병원 외과학교실

Abstract


Purpose:Preoperatvie radiotherapy has many theoretical advantages in contrast to postoperative one such as preventing dissemination of cancer cells during surgery and increasing resectability rate by down-staging, thus more feasibility of preserving anus and improving survival. But there are several adverse effects, too. Distant metastasis can be detected after preoperative radiotherapy. Postoperative complication rate is high. Pathologic stage is changed after preoperative radiationtherapy so that there is difficulty in prediction of prognosis. We reviewed distant metastasis after preoperative radiotherapy and evaluated detection rate of metastasis with computed tomography in rectal cancer.

Methods:Fifty patients with histologically proven rectal cancer and locally advanced lesions, as determined by physical examination and with no distant metastasis on preoperative computed tomography, entered the trial from 1990 to 1999. Surgery followed 2 to 6 weeks after completion of hyperthermia-chemoradiotherapy (HTCRT). Preoperative stages were determined with computed tomography. Postoperatve stage were determined by pathologic study.

Results:Thirty cases were male. Twenty cases were female. Distance from anal verge to tumor were under 7 ㎝ of 36 cases, over of 14 cases. The median tumor size was 3.3 ㎝ in diameter. The conservation rate of anal sphincter unction were 48.0%. In preoperative staging with computed tomography, the number of stage Ⅰ, Ⅱ, and Ⅲ were 4, 11 and 35 cases. none were stage Ⅳ. The overall resectability rate was 90.0% (45 of 50 patients). In postoperative staging with pathologic study, the number of stage 0, Ⅰ, Ⅱ, and Ⅲ were 4, 5, 19, and 13 cases. stage Ⅳ were 9 cases. Anastomotic leakage were noticed in 2 cases. In stage Ⅳ cases, liver metastases were noticed in all cases.

Conclusions:The preoperative radiotherapy was applied to the 50 patients with rectal cancer. The liver metastases which were detected after preoperative radiotherapy were 9 cases. The false negative value of computed tomography for liver metastasis in rectal cancer was 18.0%. We need more sensitive study for detecting liver metastasis of rectal cancer, especially in scheduled preoperative radiotherapy.

키워드

직장암;술 전 방사선치료;간 전이;전산화단층촬영
Rectal cancer;Preoperative radiotherapy;Liver metastasis;Computed tomography
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