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경항문 내시경 미세수술 후 부가적 치료 여부의 결정: 36명의 고위험군 직장암 환자에 대한 임상적 경험

Decision of Salvage Treatment after Transanal Endoscopic Microsurgery: Clinical Experience on 36 Cases of Rectal Cancer

대한대장항문학회지 2005년 21권 6호 p.406 ~ 412
신숙희 ( Sin Sook-Hee ) - 성균관대학교 의과대학 삼성서울병원 외과학교실

한상아 ( Han Sang-Ah ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
박치민 ( Park Chi-Min ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
윤성현 ( Yun Seong-Hyeon ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
이우용 ( Lee Woo-Yong ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
최동욱 ( Choi Dong-Wook ) - 성균관대학교 의과대학 삼성서울병원 외과
전호경 ( Chun Ho-Kyung ) - 성균관대학교 의과대학 삼성서울병원 외과학교실

Abstract


Purpose: Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation.

Methods: From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin.

Results: Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions.

Conclusions: In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion. J Korean Soc Coloproctol 2005;21:406-412

키워드

경항문 내시경 미세수술;직장암;국소 재발;국소 절제술
Transanal endoscopic microsurgery;Rectal cancer;Local recurrence;Local excision
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