Journal of the Korean Cancer Association 1985;17(1): 85-94.
직장암 치료에 있어서 수술의 선택과 원위부 장절제 범위가 국소 재발에 미치는 영향
김진복, 박재갑, 김선회
Local Recurrence after Curative Resection for Rectal and Rectosigmoid Carcinoma : Relationship with various factors including extent of distal clearance
The hospital records of 267 patients who had undergone curative resection for rectal or rectosigmoid cancer at Seoul National University Hospital between 1974 and 1982 were reviewed. Of these, 34 patients were lost to follow-up and the status of recurrence of 51 patients were unknown. The remaining 182 Patients were analysed to ascertain whether there is any correlation between local recurrence rate and various factors including the length of normal rectum removed below the tumor. Fifty one patients(28%) developed local recurrence; 39/115(34%) after abdominoperineal excision and 12/67(18%) after sphincter- saving operation. Clinical stage, location of tumor, histolagic differentiation, number of .etastatic lymph nodes and adhesion to surrounding tissue as an operative finding were 'ound to have an influence on the local recurrence rate. There was no difference in the ocal recurrence rate between two types of operation for Dukes C lesion excluding low rectal :ancers. Of the 67 patients who had undergone sphincter-saving operation, the length of the ectum excised below the tumor was less than 2 cm in 10 patients(group 1), 2 cm or more .nd less than 5 cm in 15 patients(group 2) and 5 cm or more in 42 patients(group 3). The ates of local recurrence of group 1, 2 and 3 were 30i.(3/10), 13. 3%(2/15) and 16. 7%(7/42). But the proportian of the patients who had metastatic lymph nodes, especially multiple ymph node involvement was significantly larger in group 1 than in other groups. All the cases in group 1 developed local recurrence at the anastomosis site. These results suggest hat clinical stage and other risk factors has more important role on increasing rate of local :currence than the length of the rectum excised below tumor, but a margin less than 2 cm elow the tumor increases the risk of suture line recurrence.
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