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선택적 진행성 직장암에서의 요크-메이슨 수술의 효용성

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer

대한대장항문학회지 2009년 25권 3호 p.178 ~ 185
정운경 ( Jeong Woon-Kyong ) - 국립암센터 암예방검진센터

백성규 ( Baek Seong-Kyu ) - 계명대학교 의과대학 외과학교실
배옥석 ( Bae Ok-Suk ) - 계명대학교 의과대학 외과학교실

Abstract


Purpose: The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers.

Methods: From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively.

Results: The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%).

Conclusions: The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

키워드

요크-메이슨 수술;경괄약근절제술;국소 절제술;직장암
York-Mason operation;Transsphincteric excision;Local excision;Rectal cancer
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