절제 가능한 직장암의 종양특이 직장간막절제술 후 종양학적 치료성적 및 안정성: 1,276예 분석
Oncologic Outcomes and Safety after Tumor-specific Mesorectal Excision for Resectable Rectal Cancer: A Single Institution’s Experience with 1,276 Patients with Rectal Cancer
김남규, 민병소, 허혁, 이강영, 손승국, 조장환, 김진수,
소속 상세정보
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
민병소 ( Min Byung-Soh )
연세대학교 의과대학 외과학교실
허혁 ( Hur Hyuk )
연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
조장환 ( Cho Jang-Hwan )
연세대학교 의과대학 외과학교실
김진수 ( Kim Jin-Soo )
연세대학교 의과대학 외과학교실
KMID : 0356720080240020121
Abstract
Purpose: The purpose of this work was to review the oncologic outcomes and the operative safety of a tumor- specific mesorectal excision (TSME) for resectable rectal cancer. The risk factors for recurrence and survival were analyzed, and the changes in the sphincter-preserving rate with time were analyzed.
Methods: A total of 1,276 patients with rectal cancer who underwent curative surgery between 1989 and 2003 were analyzed retrospectively. The enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively.
Results: The pathologic stages were stage I in 330 (25.9%), II in 403 (31.6%), and III in 543 (42.6%). Postoperative complications developed in 263 patients (20.6%). The rates of anal sphincter preservation were 32.6% between 1989 and 1993, 56.8% between 1994 and 1998, and 69.4 % between 1999 and 2003. With a mean follow-up of 69.4 months, the overall local recurrence (LR) rate was 5.4%. The 5-year LR rates were 3.8% in stage I, 4.7% in stage II, and 8.4% in stage III (P=0.016). A multivariate analysis revealed that the risk factors affecting LR were pN (0.005) and preoperatively increased serum CEA (P=0.008). The 5-year cancer-specific survival rates were 93.8% in stage I, 84.5% in stage II, and 64.5% in stage III (P=0.021). A multivariate analysis revealed that the factors affecting cancer-specific survival were pN (P=0.012) and circumferential resection margin (P＜0.001).
Conclusions: TSME for resectable rectal cancer showed acceptable operative morbidity and excellent oncologic outcomes. The trend toward sphincter preservation was obvious, and the shortening of the distal resection margin without deteriorating the oncologic outcomes was one of the major enabling factors. J Korean Soc Coloproctol 2008;24:121-133
키워드
직장암;종양특이 직장간막절제술;종양학적 치료성적;안전성
Rectal cancer;Tumor specific mesorectal excision;Oncologic outcomes;Safety
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