Transanal Minimally-Invasive Surgery for Treating Patients With Regressed Rectal Cancer After Preoperative Chemoradiotherapy

이병철; 오선옥; 임석병; 유창식; 김진천

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자료유형: 학술저널

저자정보: 이병철 (울산대학교) 오선옥 (울산대학교) 임석병 (울산대학교) 유창식 (울산대학교) 김진천 (울산대학교)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.33 No.2

발행연도: 2017.1

수록면: 52 - 56 (5page)

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Purpose: Although the standard treatment for patients with locally advanced rectal cancer managed by preoperative chemoradiotherapy (CRT) is a radical resection, local excisions are used in highly-selective cases. Recently, transanal minimally-invasive surgery (TAMIS) has emerged as a feasible technique for local excision of midrectal lesions. We assess the feasibility of using TAMIS to treat patients with locally advanced rectal cancer who showed good response to CRT. Methods: From October 2010 to June 2013, 35 consecutive patients with rectal cancer managed by using preoperative CRT underwent TAMIS. After a single-incision laparoscopic surgery port had been introduced into the anal canal, a fullthickness local excision with conventional laparoscopic instruments was performed. We retrospectively reviewed a prospectively collected database of these cases. Results: Of the 35 patients analyzed, 18 showed pathologic complete responses and 17 had residual lesions (2 ypTis, 4 ypT1, 9 ypT2, and 2 ypT3); 34 (97.1%) showed clear deep, lateral margins. The median distance of lesions from the anal verge was 5 cm. All procedures were completed laparoscopically, and the median operating time was 84 minutes. No intraoperative events or morbidities were seen in any of the patients, except one with wound dehiscence, who was treated conservatively. The median postoperative hospital stay and follow-up period were 4 days and 36 months, respectively. During the study period, no patients died, but 5 (14.3%) experienced recurrence, including one recurrence at the TAMIS site. Conclusion: TAMIS seems to be a feasible, safe modality for treating patients with locally advanced rectal cancer who show good response to preoperative CRT.

참고문헌 (17)

참고문헌 신청

National Comprehensive Cancer Network / NCCN guidelines version 1.2015: Rectal Cancer 2015

Hingorani M / 2012 / Avoiding radical surgery after pre-operative chemoradiotherapy: a possible therapeutic option in rectal cancer? / Acta Oncol 51:275~284

Papagrigoriadis S / 2006 / Transanal endoscopic micro-surgery (TEMS)for the management of large or sessile rectal adenomas: a review of the technique and indications / Int Semin Surg Oncol 3:13

Maslekar S / 2007 / Cost analysis of transanal endoscopic microsurgery for rectal tumours / Colorectal Dis 9:229~234

Atallah S / 2010 / Transanal minimally invasive surgery:a giant leap forward / Surg Endosc 24:2200~2205

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