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대장암에서 수술 중 발견된 동시성 간전이암의 특징 및 치료성적

Comparative Analysis of Colorectal Cancer with Liver Metastasis Identified Preoperatively vs. Intraoperatively

대한대장항문학회지 2004년 20권 6호 p.378 ~ 383
박인자 ( Park In-Ja ) - 울산대학교 의과대학 외과학교실

김희정 ( Kim Hee-Jeong ) - 울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
장흥문 ( Chang Heung-Moon ) - 울산대학교 의과대학 서울아산병원 외과학교실
류민희 ( Ryu Min-Hee ) - 울산대학교 의과대학 외과학교실
김종훈 ( Kim Jong-Hoon ) - 울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실

Abstract


Purpose: Current diagnostic modalities frequently carry false negative evaluations, especially in micro-metastasis. Some metastases are identified incidentally during the operation for primary colorectal cancer. Our study was performed to assess the clinicopathological characteristics of intraoperatively diagnosed liver metastases, to analyze the survival and the prognosis, to compare the results with those for preoperatively diagnosed liver metastases.

Methods: Between July 1989 and December 2001, the cases of 78 patients who underwent treatment for intraoperatively diagnosed liver metastasis at our hospital were analyzed retrospectively. There were 375 patients who were diagnosed with liver metastasis preoperatively during the same period. Metachronous liver metastases were excluded.

Results: Intraoperatively diagnosed liver metastases mostly showed clinicopathological characteristics of primary colorectal cancer similar to those for preoperatively diagnosed liver metastases. On the other hand, the preoperative serum CEA level was significantly lower in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P<0.001). For the metastatic lesion, the size of the metastasis was smaller in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P=0.03). The two-year survival rate of the intraoperatively diagnosed group was significantly better than that of the preoperatively diagnosed group (71.6% vs. 58.4%; P=0.031). Prognostic factors of the intraoperatively diagnosed group were the number of liver metastases, a curative operation for the primary cancer, and an operation for the metastatic lesion.

Conclusions: Intraoperatively diagnosed liver metastases had biologic features similar to those of preoperatively diagnosed liver metastases. The survival rate of the intraoperatively diagnosed group was better than that of the preoperatively diagnosed group, possibly due to the curative resection for the hepatic metastases. Therefore, aggressive treatment for primary and metastatic lesions is the therapeutic choice to improve patient’s survival for intraoperatively diagnosed synchronous liver metastases. J Korean Soc Coloproctol 2004;20:378- 383

키워드

대장암;간전이;수술 전;수술 중
olorectal neoplasm;Liver metastasis;Intraoperative;Preoperative
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