하부 직장암에서 괄약근보존술과 복회음절제술의 장기적 종양학적 결과
The Long-term Oncological Outcome of a Sphincter-saving Resection and an Abdominoperineal Resection for Lower Rectal Cancer
정상훈, 유창식, 최평화, 김대동, 홍동현, 김희철, 김진천,
소속 상세정보
정상훈 ( Jung Sang-Hun )
울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik )
울산대학교 의과대학 서울아산병원 외과학교실
최평화 ( Choi Pyong-Wha )
울산대학교 의과대학 서울아산병원 외과학교실
김대동 ( Kim Dae-Dong )
울산대학교 의과대학 서울아산병원 외과학교실
홍동현 ( Hong Dong-hyun )
울산대학교 의과대학 서울아산병원 외과학교실
김희철 ( Kim Hee-Cheol )
울산대학교 의과대학 서울아산병원 외과학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 서울아산병원 외과학교실
KMID : 0356720070230030186
Abstract
Purpose:The oncological safety of a sphincter-saving resection (SSR) in lower rectal cancer is widely accepted, and both an abdominoperineal resection (APR) and a SSR are used in potentially curative surgery. This retrospective study was performed to compare the long-term oncological outcomes after an APR and a SSR in patients with lower rectal cancer (within 5 cm from the anal verge).
Methods:We recruited 441 lower rectal cancer patients who underwent curative resections (APR: 305, SSR: 136) between 1995 and 2000. A total mesorectal excision and autonomic nerve preservation were routinely performed. The median follow- up period was 65 months.
Results: Most demographic findings were comparable between the groups; however, the APR groups revealed more advanced pathological characteristics (tumor depth, size, cell differentiation, and metastatic LN number). The local recurrence rates after an APR and a SSR were 12.8% and 7.4%, respectively (P= 0.09). An independent risk factor of local recurrence was LN metastasis only. Distant recurrence was higher in the APR group (26.4%) than in the SSR group (13.2%), but on multivariate analysis the difference was not significant (P=0.17). The 5-year cancer-specific survival rates after an APR and a SSR were 73.2% and 87.6%, respectively (P＜0.05). Particularly, there was a significant survival difference for stage III patients (APR: 59.0% vs. SSR: 83.0%, P＜0.05). However, an APR was not an indepen dent prognostic factor for cancer-specific survival in the multivariate analysis (P=0.07).
Conclusions:An APR per se did not influence local recurrence after a curative resection for lower rectal cancer. The poor cancer-specific survival in the stage III APR group might be attributed to increased distant metastasis due to its more distal location. J Korean Soc Coloproctol 2007;23:186-193
키워드
괄약근보존술;복회음절제술;재발;생존율
Sphincter-saving resection;Abdominoperineal resection;Recurrence;Survival rate
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