직장암 수술 후 문합부 누출의 위험인자와 예후에 미치는 영향
Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery
정상훈, 유창식, 최평화, 김대동, 홍동현, 김희철, 김진천,
소속 상세정보
정상훈 ( Jung Sang-Hun )
울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik )
울산대학교 의과대학 외과학교실
최평화 ( Choi Pyong-Wha )
울산대학교 의과대학 외과학교실
김대동 ( Kim Dae-Dong )
울산대학교 의과대학 외과학교실
홍동현 ( Hong Dong-Hyun )
울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol )
울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 외과학교실
KMID : 0356720060220060371
Abstract
Purpose: Anastomotic leakage (AL) is a serious and life- threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery.
Methods: We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2∼96 months).
Results: AL rate was 2.5% (n=35). Gender (male), age (＞60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18∼7.22; HR: 2.42, 95% CI: 1.12∼7.83; HR: 2.68, 95% CI: 1.08∼7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P＜0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P＜0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05).
Conclusion: Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival. J Korean Soc Coloproctol 2006;22:371-379
키워드
문합부 누출;직장암 수술;위험인자;생존율
Anastomotic leakage;Rectal cancer surgery;Risk factor;Survival rate
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