직장암에서 전층절편 조직 검사를 통한 직장간막 미세종양 결절과 측방 절제연에 관한 임상연구

다국어 초록 (Multilingual Abstract)

Purpose: Total mesorectal excision (TME) has been widely accepted as the principal method in rectal cancer surgery and demonstrates good oncologic and functional outcome. The recurrence rate of mid-low rectal cancer surgery with TME is reported as 5∼6%. Concerning local recurrence, remaining microscopic nodules in mesorectum are a major issue. In this study, we investigated mesorectal spread of tumors and exact lateral resection margin using whole mount section (WMS) to obtain correlations with other clinico-pathological variables.
Methods: 63 rectal cancer patients underwent surgery with TME and WMS at National Health Insurance Corporation Ilsan Hospital between December 2005 and October 2008. Preoperative study was made by computed tomography (CT), magnetic resonance imaging (MRI). We measured the distance from the largest cut section of the primary tumor to the nearest circumferential margin using MRI and compared them to lateral resection margins in WMS.
Results: Among 63 patients, the sex ratio was 1：1.17 and the median age was 62.7 years. There were 34 patients in TNM stage Ⅲ (54.0%), 21 patients in stage Ⅱ (33.3%) and 8 patients in stage Ⅰ (12.7%). Lateral margin involvement was predicted in 4 cases pre-operatively and confirmed in 3 cases with WMS. Micrometastasis in mesorectum was detected in 6 patients (9.5%) and all were in stage Ⅲ. N stage was statistically correlated with micrometastasis (P=0.016).
Conclusion: WMS offers precise lateral resection margin and mesorectal spread of microscopic tumor nodules. WMS is best considered in stage Ⅲ cancer to evaluate mesorectal micrometastasis. The mid-low rectal cancer cases with predicted lateral margin involvements using MRI should be operated on with great care.

목차 (Table of Contents)

• 서론
• 방법
• 결과
• 고찰
• 결론
• REFERENCES

참고문헌 (Reference)

1 백승혁, "직장암에서 전 직장간막 절제술 후 측방절제연이 예후에 미치는 영향" 대한대장항문학회 21 (21): 307-313, 2005

2 Nagtegaal ID, "What is the role for the circumferential margin in the modern treatment of rectal cancer?" 26 : 303-312, 2008

3 Paty PB, "Treatment of rectal cancer by low anterior resection with coloanal anastomosis" 219 : 365-373, 1994

4 Scott N, "Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer" 82 : 1031-1033, 1995

5 Glass RE, "The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy" 72 : 599-601, 1985

6 Williams NS, "The rationale for preservation of the anal sphincter in patients with low rectal cancer" 71 : 575-581, 1984

7 Quirke P, "The prediction of local recurrence in rectal adenocarcinoma by histopathological examination" 3 : 127-131, 1988

8 Heald RJ, "The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?" 69 : 613-616, 1982

9 Lee SH, "The effect of circumferential tumor location in clinical outcomes of rectal cancer patients treated with total mesorectal excision" 48 : 2249-2257, 2005

10 Ng IO, "Surgical lateral clearance in resected rectal carcinomas. A multivariate analysis of clinicopathologic features" 71 : 1972-1976, 1993

11 Moriya Y, "Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection" 32 : 307-315, 1989

12 Heald RJ, "Recurrence and survival after total mesorectal excision for rectal cancer" 1 : 1479-1482, 1986

13 Williams NS, "Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival" 70 : 150-154, 1983

14 Ueno H, "Prognostic significance of extranodal microscopic foci discontinuous with primary lesion in rectal cancer" 41 : 55-61, 1998

15 Camma C, "Preoperative radiotherapy for resectable rectal cancer: A meta-analysis" 284 : 1008-1015, 2000

16 Kapiteijn E, "Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer" 345 : 638-646, 2001

17 Lee KY, "Pattern of recurrence after curative resection for rectal cancer" 61 : 588-592, 2001

18 Zhao GP, "Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin" 11 : 319-322, 2005

19 Reynolds JV, "Pathological evidence in support of total mesorectal excision in the management of rectal cancer" 83 : 1112-1115, 1996

20 Wang Z, "Microscopic spread of low rectal cancer in regions of mesorectum: pathologic assessment with whole-mount sections" 10 : 2949-2953, 2004

21 Quirke P, "Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision" 2 : 996-999, 1986

22 Soreide O, "Local recurrence after operative treatment of rectal carcinoma: a strategy for change" 184 : 84-92, 1997

23 Cawthorn SJ, "Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer" 335 : 1055-1059, 1990

24 Koyama Y, "Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum--significant improvement of survival rate and decrease of local recurrence" 14 : 623-632, 1984

25 Shirouzu K, "Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery" 76 : 388-392, 1995

26 Ono C, "Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ" 45 : 744-749, 2002

27 Cawthorn SJ, "Clearance technique for the detection of lymph nodes in colorectal cancer" 73 : 58-60, 1986

28 Andreola S, "Adenocarcinoma of the lower third of the rectum: metastases in lymph nodes smaller than 5 mm and occult micrometastases; preliminary results on early tumor recurrence" 8 : 413-417, 2001

29 Penfold JC, "A comparison of restorative resection of carcinoma of the middle third of the rectum with abdominoperineal excision" 44 : 354-356, 1974