직장암환자에서 근치적 절제 후 재발 양상의 분석
Pattern of Recurrence after Curative Resection for Rectal Cancer
이강영, 김성민, 김남규, 박재균, 손승국, 민진식,
소속 상세정보
이강영 ( Rhee Kang-Young )
연세대학교 의과대학 외과학교실
김성민 ( Kim Seong-Min )
연세대학교 의과대학 외과학교실
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
박재균 ( Park Jea-Kun )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
민진식 ( Min Jin-Sik )
연세대학교 의과대학 외과학교실
KMID : 0371320010610060588
Abstract
>Purpose : The aim of this study was to evaluate the rate and pattern of recurrence of rectal cancer as well as analyze the risk factors affecting recurrence following resection with curative intent.
Methods : 460 patients underwent curative resection for adenocarcinoma of the rectum at our clinic from 1994 to 1998. Among these, 132 patients (29.1%) whose recurrence was confirmed by clinical and radiologic examination or reoperation
were
studied retrospectively. The risk factors that determined the recurrence patterns were analysed with univariate and multivariate analyses.
Results : The mean time to recurrence was 22.0 months. The locoregional recurrence rate was 5.7% (25/440). The systemic recurrence rate was 18.4% (81/440). 12 patients (2.7%) had two or more sites of recurrence at the time of diagnosis.
The
most
common locoregional recurrence was a pelvic recurrence (2.3%; 10/440), followed by anastomosis (2.0%; 9/440) and presacral (0.9%; 4/440). The most common site of systemic recurrence was the liver (7.0%; 31/440), followed by the lung (5.9%;
26/440)
and
peritoneum (3.2%; 14/440). The mean time from recurrence to death was 16.0 months. Logistic regression analysis demonstrated that nodal metastasis (P=0.002), vascular invasion (P=0.027), elevated CEA level (P=0.011), and microscopic invasion to
the
lateral margin (P=0.008) were risk factors for postoperative recurrence. When the recurrence patterns were compared to stage, the systemic recurrence rate was 3.0% in stage Ⅰ, 15.3% in stage Ⅱ, and 28.9% in stage Ⅲ. The locoregional recurrence
rate
was 3.0% in stage Ⅰ, 6.0% in stage Ⅱ, and 6.8% in stage Ⅲ.
Conclusion : Even though an excellent local control was obtained following curative resection of rectal cancer, the main cause of recurrence was a systemic failure in advanced rectal cancer. More effective systemic chemotherapy is required
for
the prevention of systemic recurrence.
키워드
직장암; 재발; 근치적 절제술; Rectal cancer; Recurrence; Curative resection;
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