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직장암 수술 후 골반 내 국소재발의 분류와 예후

Local Pelvic Recurrence after Curative Resection of the Rectal Cancer: Classification and Prognosis

대한대장항문학회지 2005년 21권 2호 p.82 ~ 88
박재균 ( Park Jae-Kun ) - 홍익병원 외과

김남규 ( Kim Nam-Kyu ) - 연세대학교 의과대학 외과학교실
백승혁 ( Paik Seung-Hyuk ) - 연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young ) - 연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook ) - 연세대학교 의과대학 외과학교실
조장환 ( Cho Jang-Hwan ) - 연세대학교 의과대학 외과학교실

Abstract


Purpose: The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type.

Methods: A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure.

Results: Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2±30.0 months and mean recurrence time between primary operation and recurrence was 26.0±22.7 months.

Conclusions: Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.

키워드

직장암;골반 내 국소재발;분류;예후
Rectal cancer;Local pelvic recurrence;Classification;Prognosis
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