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국소 진행된 원위부 직장암에 대한 수술 전 화학방사선치료 후 복회음 절제술 치료성적

Abdominoperineal Resection in the Treatment of Locally-advanced Low Rectal Cancer: Is Preoperative Chemoradiation Advantageous?

대한대장항문학회지 2010년 26권 2호 p.129 ~ 136
김정연 ( Kim Jeong-Yeon ) - 연세대학교 의과대학 외과학교실

김진수 ( Kim Jin-Soo ) - 연세대학교 의과대학 외과학교실
민병소 ( Min Byung-Soh ) - 연세대학교 의과대학 외과학교실
허혁 ( Hur Hyuk ) - 연세대학교 의과대학 외과학교실
김영완 ( Kim Young-Wan ) - 연세대학교 의과대학 외과학교실
김남규 ( Kim Nam-Kyu ) - 연세대학교 의과대학 외과학교실


Purpose: An abdominoperineal resection (APR) has a poor prognosis. However, limited studies about the prognostic factors in APR and the role of preoperative chemoradiotherapy (CRT) have been performed even though in rectal cancer, the application of preoperative CRT provides better local control compared to postoperative CRT. The aim of this study was to identify the prognostic factors and the impact of preoperative CRT in patients who undergo an APR.

Methods: A retrospective analysis was conducted with a total of 133 patients who underwent an APR, cT3, cT4, or cN(+) patients, for rectal cancer between January 1995 and October 2004. Fifty-one patients treated with preoperative CRT (Group 1) were compared with 82 APR patients treated with postoperative CRT (Group 2). Oncologic outcomes were compared between the two groups, and the clinicopathologic factors affecting the treatment outcomes were evaluated.

Results: The median follow-up period was 61.2 mo (range 6 to 194 mo). Circumferential margin (CRM) involvement was significantly associated with local recurrence (LR) and with disease-free survival in APR patients (P<0.001, P=0.011). The 5-yr LR rate was significantly lower in Group 1 than in Group 2 (P=0.013) in the univariate analysis, but no difference was noted in multivariate analysis (P=0.315). In Group 1, CRM involvement, tumor size, and lymph node metastasis were significantly lower than they were in Group 2 (P=0.043, P=0.003, P<0.001).

Conclusion: For achieving adequate oncologic outcomes in APR patients, an adequate CRM should be acquired with an optimal operation. In addition, preoperative CRT would be helpful for high-risk APR patients with a threatening CRM margin, providing the benefit of tumor downstaging.


복회음 절제술;수술 전 항암 화학 요법;국소 재발률;측방 절제면
Abdominoperineal resection;Preoperative chemoradiation therapy;Local recurrence;Circumferential resection margin
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