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폐쇄성 좌측 대장암에서 스텐트 삽입 후 단단계 복강경 대장 절제술의 단기 예후: 비폐쇄성 좌측 대장암의 복강경 대장 절제술군과의 비교

Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers

대한대장항문학회지 2009년 25권 6호 p.417 ~ 422
김현실 ( Kim Hyun-Sil ) - 가톨릭대학교 의과대학 외과학교실

김성근 ( Kim Sung-Geun ) - 가톨릭대학교 의과대학 외과학교실
안창혁 ( An Chang-Hyeok ) - 가톨릭대학교 의과대학 외과학교실
강원경 ( Kang Won-Kyung ) - 가톨릭대학교 의과대학 외과학교실
이윤석 ( Lee Yoon-Suk ) - 가톨릭대학교 의과대학 외과학교실
이인규 ( Lee In-Kyu ) - 가톨릭대학교 의과대학 외과학교실
김형진 ( Kim Hyung Jin ) - 가톨릭대학교 의과대학 외과학교실
이상철 ( Lee Sang-Chul ) - 가톨릭대학교 의과대학 외과학교실
조현민 ( Cho Hyeon-Min ) - 가톨릭대학교 의과대학 외과학교실
박종경 ( Park Jong-Kyung ) - 가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack ) - 가톨릭대학교 의과대학 외과학교실
김준기 ( Kim Jun-Gi ) - 가톨릭대학교 의과대학 외과학교실

Abstract


Purpose: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer.

Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate.

Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0± 8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups.

Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

키워드

단단계 복강경 대장 절제술;스텐트 삽입술;폐쇄성 좌측 대장암
One-stage laparoscopic colorectal resection;Stent insertion;Left-sided colon cancer
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