선택된 하부 직장암 환자에서 수술 전 항암 화학약물 및 방사선 병행 치료 후 시행한 경항문 내시경 미세수술 = Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients

다국어 초록 (Multilingual Abstract)

Purpose: Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT. Methods: Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4～7 weeks following the completion of therapy. Results: The mean age was 54.9 (35～70) years and the median follow-up period was 23.0 (5～57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period. Conclusions: TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.

참고문헌 (Reference)

1 "a valid treatment for rectal cancer" 10 : 736-741, 1996

2 "Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer" 44 : 1027-1038, 1999

3 "Transanal local excision of selected low rectal cancer" 175 : 360-363, 1998

4 "Transanal endoscopic microsurgery" 35 : 1183-91, 1992

5 "T1,T2 직장암에 대한 경항문 내시경 미세수술과 광범위 절제술의 치료성적 비교" 18 : 240-245, 2002

6 "Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer" 63 : 1421-9, 1989

7 "Rectal carcinoma treated by preoperative irradiation:MR imaging and histopathologic correlation" 158 : 287-92, 1992

8 "Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils" 137 : 447-451, 2002

9 "Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers" 17 : 54-58, 2002

10 "Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum" 221 : 778-786, 1995

11 "Patterns of failure following local excision and local excision and postoperative radiation therapy for invasive rectal adenocarcinoma" 7 : 1003-8, 1989

12 "Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy:long-term results" 240 : 711-717, 2004

13 "Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients" 60 : 1098-1105, 2004

14 "Long-term follow-up of local excision and radiation therapy for invasive rectal cancer" 38 : 1193-1199, 1995

15 "Local excision of rectal carcinoma" 160 : 306-12, 1990

16 "Local excision of rectal cancer without adjuvant therapy" 231 : 345-351, 2000

17 "Local excision of T2 and T3 rectal cancers after downstaging chemoradiation" 234 : 352-359, 2001

18 "Local excision and postoperative radiation therapy for rectal cancer" 17 : 411-6, 1994

19 "Is local excision adequate therapy for early rectal cancer" 43 : 1064-1074, 2000

20 "Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy" 48 : 23-28, 2005

21 "How accurate is endorectal ultrasound in the preoperative staging of rectal cancer" 36 : 127-34, 1993

22 "High-dose preoperative radiation and full thickness local excision:a new option for selected T3 distal rectal cancers" 30 : 845-849, 1994

23 "Endorectal ultrasonography for the assessment of invasion of rectal tumors and lymph node involvement" 77 : 883-7, 1990

24 "Endorectal surface coil MR imaging as a staging technique for rectal carcinoma:a comparison study to rectal endosonography" 25 : 75-80, 2000

25 "Early evaluation using PET-FDG of the efficiency of neoadjuvant radiochemotherapy treatment in locally advanced neoplasia of the lower rectum" 89 : 50-53, 2003

26 "Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation" 30 : 169-75, 1994

27 "Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparison with endoscopic rectal sonography" 64 : 312-317, 1997

28 "18F-FDG positron emission tomography staging and restaging in the rectal cancer treated with preoperative chemoradiation" 58 : 528-535, 2004