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초저위 직장암에서 항문괄약근간 절제술

Intersphincteric Resection for Very Low Rectal Cancer

대한대장항문학회지 2004년 20권 6호 p.364 ~ 370
김재훈 ( Kim Jae-Hoon ) - 부산대학교 의과대학 외과학교실

오남건 ( Oh Nahm-Gun ) - 부산대학교 의과대학 외과학교실

Abstract


Purpose: In the treatment of rectal cancer, sphincter saving resection is increased but low anterior resection is limited in treatment for low rectal cancer below 4 cm from the anal verge. In other reports intersphincteric resection can allow an oncologically safe resection margin and has good functional results in very low rectal cancer. The aim of this study is to evaluate the morbidity, mortality and the oncological and functional results of intersphincteric resection.

Methods: Between 2000 and 2002, 18 patients (mean age 54 years, range 35~70) with adenocarcinoma of the rectum underwent intersphincteric resection by an transanal approach with a colonic J-pouch anal anastomosis and ileostomy. The mean distance between the tumor and anal verge was 3.75 (range 2.5~5) cm. Patients with T3 lesion were 8 and they were received preoperative radiochemotherapy. Others with T2 lesion were not received preoperative radiochemotherapy.

Results: There was no postoperative mortality and local recurrance after median follow up of 32 (18~54) months. Morbidity occurred in 9 patient but were not serious. Two anastomotic leakages occurred. One was recovered after only conservative therapy, but the other one was received colostomy because of functional problem. Downstaging was observed in 62.5% (5/8) of the patients. Continence was good (Kirwan classification I, II) in 72% (13/18) of patients.

Conclusions: These results suggest that intersphincteric resection can be an alternative procedure to abdominoperineal resection for very low rectal cancer without losing chance of cure. J Korean Soc Coloproctol 2004;20:364-370

키워드

항문괄약근간 절제술;직장암;화학방사선요법
Intersphincteric resection;Rectal cancer;Chemoradiation therapy
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