치핵절제술 시 진단되지 않은 항문직장암
Anorectal Cancer Undetected at the Time of Hemorrhoidectomy
강성범, 허승철, 정승용, 최효성, 박규주, 박재갑,
소속 상세정보
강성범 ( Kang Sung-Bum )
서울대학교 의과대학 외과학교실
허승철 ( Heo Seung-Chul )
서울대학교 의과대학 외과학교실
정승용 ( Jeong Seung-Yong )
국립암센터 대장암센터
최효성 ( Choi Hyo-Seong )
국립암센터 대장암센터
박규주 ( Park Kyu-Joo )
서울대학교 의과대학 외과학교실
박재갑 ( Park Jae-Gahb )
서울대학교 의과대학 외과학교실
KMID : 0356720020180020110
Abstract
Purpose: Concomitant rectal cancer in a patient with hemorrhoids may be not recognized at the time of hemorrhoidectomy. This study aimed to increase awareness of this entity.
Methods:We reviewed 12 anorectal cancers that were diagnosed within or one year after hemorrhoidectomy, which had been performed in other hospitals. They were followed for a median time of 22.7 months (range, 2 to 80 months) after surgical treatment of anorectal cancers.
Results:Symptoms at diagnosis of cancer were rectal bleeding (67%), defecation difficulty (17%), diarrhea (8%) and anal mass (8%). Eleven tumors (92%) were within the topographic location reachable by digital examination, with median distance of 6 ㎝ from anal verge to the inferior margin of tumor (range, 1 to 10 ㎝). The median size of tumor was 4.5 ㎝ (range, 2 to 7 ㎝). According to histologic type, there were Ⅱ adenocarcinomas and Ⅰ malignant melanoma. The malignant melanoma was located at the incisional scar of hemorrhoidectomy and was found at an advanced stage with lymph node metastasis to the aortic bifurcation area. Surgical treatments were sphincter-saving resection in 10 cases and abdominoperineal resection in 2 cases. On follow-up examination, one case was recurred at the previous incisional scar of hemorrhoidectomy 12 months after low anterior resection due to rectal cancer.
Conclusions:Most of anorectal cancers missed at the time of hemorrhoidectomy were within the topographic
location reachable by digital rectal examination. We found that the hemorrhoidectomy under the missed diagnosis of anorectal cancer amy induce intraluminal seeding of the anorectal cancer may induce intraluminal seeding of the cancer at the incisional scar of hemorrhoidectomy. To prevent this complication, we suggests that the anorectum of hemorrhoidal patients should be examined carefully preoperatively and under anesthesia.
키워드
치핵;항문직장암
Hemorrhoid;Anorectal cancer
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