선택된 하부 직장암 환자에서 수술 전 항암 화학약물 및 방사선 병행 치료 후 시행한 경항문 내시경 미세수술
Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients
박치민, 윤성현, 이우용, 전호경, 정극원, 한상아,
소속 상세정보
박치민 ( Park Chi-Min )
성균관대학교 의과대학 삼성서울병원 외과학교실
윤성현 ( Yun Seong-Hyeon )
성균관대학교 의과대학 삼성서울병원 외과학교실
이우용 ( Lee Woo-Yong )
성균관대학교 의과대학 삼성서울병원 외과학교실
전호경 ( Chun Ho-Kyung )
성균관대학교 의과대학 삼성서울병원 외과학교실
정극원 ( Jung Keuk-Won )
성균관대학교 의과대학 삼성서울병원 외과
한상아 ( Han Sang-Ah )
성균관대학교 의과대학 삼성서울병원 외과학교실
KMID : 0356720050210050293
Abstract
Purpose: Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT.
Methods: Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4∼7 weeks following the completion of therapy.
Results: The mean age was 54.9 (35∼70) years and the median follow-up period was 23.0 (5∼57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period.
Conclusions: TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer. J Korean Soc Coloproctol 2005;21:293-299
키워드
직장암;경항문 내시경 미세수술;수술 전 항암 화학약물 및 방사선 병행 치료;국소절제술
Rectal cancer;Transanal endoscopic microsurgery;Preoperative concurrent chemoradiation therapy;Local excision
원문 및 링크아웃 정보
등재저널 정보