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저위직장암에서 초저위전방절제술 후 배변기능과 종양학적 초기 성적

Functional and Oncologic Outcome of Coloanal Anastomosis in Low Lying Rectal Cancer

대한대장항문학회지 2005년 21권 6호 p.419 ~ 425
원상림 ( Won Sang-Rim ) - 연세대학교 원주의과대학 외과학교실

김익용 ( Kim Ik-Yong ) - 연세대학교 원주의과대학 외과학교실
성승훈 ( Seong Seung-Hoon ) - 연세대학교 원주의과대학 외과학교실
김대성 ( Kim Dae-Sung ) - 연세대학교 원주의과대학 외과학교실

Abstract


Purpose: Sphincter preservation is one of the main goal in the treatment of rectal cancer, but surgical management of cancer of the lower third of the rectum continues to evolve. The aim of this study was to evaluate the oncologic safety and to assess the functional results of coloanal anastomosis following ultra low anterior resection (CAA/ uLAR) in distal rectal cancer.

Methods: Thirty-six patients underwent coloanal anastomosis following ultralow anterior resection between January 2000 and February 2005. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 6 cm in length. All patients were followed up for fecal incontinence and frequency of bowel movement after diverting ileostomy closure. All patients were evaluated for local or systemic recurrences.

Results: The mean age of the patients was 58.7 (34∼82) years. The median follow-up period was 24.5 (6∼55) months. The types of anastomosis were straight anastomosis (n=25), colonic J pouch formation (n=10) and coloplasty (n=1). The twenty-nine patients of thirty-one patients underwent diverting ileostomy were performed ileostomy repair. The twenty-two patients had frequency after ileostomy repair. There is no statistical correlation of reservoir type and frequency (P=0.604). But the relationship between adjuvant radiation and frequency is statistically correlated (P=0.012). Postoperative complications were anastomotic leakage (n=5), but mostly radiological minor leakage, transient paralytic ileus (n=2), and anastomotic stenosis (n=1). The local recurrence rate is 3% and systemic recurrence occurred in 5 patients (14%), most patients were in Astler-Coller stage C.

Conclusions: Ultralow anterior resection and coloanal anastomosis in low lying rectal cancer did not seem to affect recurrence. This procedure has poor functional outcome in early period but normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation. J Korean Soc Coloproctol 2005;21:419-425

키워드

저위 직장암;대장항문문합술;기능적 결과
Distal rectal cancer;Coloanal anastomosis;Functional results
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