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복강경 결직장암 수술 후 조기 항암치료의 안전성에 관한 실험군: 대조군 비교연구

Safety of Early Chemotherapy after a Laparoscopic Colorectal Cancer Resection: A Case-Control Study

대한대장항문학회지 2009년 25권 6호 p.429 ~ 436
신승호 ( Shin Seung-Ho ) - 고려대학교 의과대학 외과학교실

이선일 ( Lee Sun-Il ) - 고려대학교 의과대학 외과학교실
최동진 ( Choi Dong-Jin ) - 고려대학교 의과대학 외과학교실
우시욱 ( Woo Si-Uk ) - 고려대학교 의과대학 외과학교실
김진 ( Kim Jin ) - 고려대학교 의과대학 외과학교실
민병욱 ( Min Byung-Wook ) - 고려대학교 의과대학 외과학교실
문홍영 ( Moon Hong-Young ) - 고려대학교 의과대학 외과학교실
김선한 ( Kim Seon-Hahn ) - 고려대학교 의과대학 외과학교실

Abstract


Purpose: Since micrometastasis is generally inhibited by primary cancer, surgical ablation of the tumor may stimulate the growth of residual cancer cells, if they exist. This supports the importance of early administration of postoperative chemotherapy.

Methods: We reviewed the cases of patients who underwent a laparoscopic resection and then received chemotherapy (5 fluorouracil+leucovorin or FOLFOX4) between September 2006 and May 2008. The chemotherapy was scheduled on the 7th or the 8th postoperative day, but was postponed when a final pathologic report was delayed or patients were discharged early. The safety of chemotherapy was evaluated in two ways. Early safety, such as the presence of surgical complications and medical toxicity, was prospectively assessed just before the beginning of the second cycle of chemotherapy. Late safety, such as medical toxicity, was retrospectively estimated from the 2nd to the last cycle. These safeties were compared between the two groups: the early chemotherapy group (n=50) for which chemotherapy started on the 7th or 8th postoperative day as scheduled and the delayed chemotherapy group (n=31) for which chemotherapy started after the 14th postoperative day.

Results: Patient demographics were not different between the two groups. With regards to early safety, no differences in surgical complications existed between the two groups. In medical toxicities, there were no differences, except for a higher rate of nausea in the early chemotherapy group (20 percent vs. 10 percent, P=0.01). With regards to late safety, the two groups were not different in the development of medical toxicities.

Conclusion: Because nausea is an easily controllable toxicity, we conclude that chemotherapy is safely started on the 7th or the 8th day after a laparoscopic colorectal cancer resection.

키워드

복강경절제술;결직장암;항암화학요법;안전성
Laparoscopic resection;Colorectal cancer;Chemotherapy;Safety
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