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직장암에서 전 직장간막 절제술 후 측방절제연이 예후에 미치는 영향

Other Titles
 Prognostic Significance of Circumferential Resection Margin following a Total Mesorectal Excision in Rectal Cancer 
 백승혁  ;  김남규  ;  이강영  ;  손승국  ;  조장환  ;  김호근  ;  라선영  ;  정현철 
 Journal of the Korean Society of Coloproctology (대한대장항문학회지), Vol.21(5) : 307-313, 2005 
Journal Title
 Journal of the Korean Society of Coloproctology (대한대장항문학회지) 
Issue Date
Circumferential resection margin ; Total mesorectal excision ; Rectal cancer
Circumferential resection margin ; Total mesorectal excision ; Rectal cancer
purpose: Studies of the circumferential resection margin (CRM) in rectal cancer surgery have revealed that inadequate surgical excision correlates with a high risk of recurrence. This study was designed to evaluate the prognostic value of the CRM in rectal cancer. Methods: All 504 patients who underwent a total mesorectal excision for rectal cancer between 1997 and 2001 were studied. The distance between the CRM and the tumor on pathology slides (HE stain, ⁓20 times) was measured. The CRM was stained by using the Davidson marking systemⰒ (Bradley Product, Inc. USA), and a micrometer was used for the measurement. We divided the patients into a negative CRM group (CRM >3 mm), an abutting CRM group (CRM ≤3 mm without involvement), and a positive CRM group (CRM was in the tumor), and compared the oncologic results among the groups. Results: The numbers of patients in the negative CRM, the abutting CRM, and the positive CRM groups were 452, 18, and 34 respectively. The mean follow- up durations were 45.1 months (range, 1.1∼88.7), 41.9 months (range, 10.7∼75.2), and 33.0 months (range, 4.8∼83.4), respectively. The Aslter-Coller stages of all patients were from B2 to C3. The local recurrence rate, the systemic recurrence rate, and the combined recurrence rate were, respectively, 5.5%, 17.3%, and 3.8% in the negative CRM group (>3 mm), 5.6%, 38.9%, and 5.6% in the abutting CRM group, and 8.8%, 44.1%, and 8.8% in the positive CRM group. The five-year survival rates for the negative CRM, the abutted CRM and the positive CRM groups were 73.3%, 48.4%, and 25.5% (P<0.001), respectively, and the disease-free 5-year survival rates were 63.1%, 30.6%, 24.0% (P<0.001). The CRM was shown to be an independent prognostic factor by multivariate analyses adjusted for known predictors of outcome (P<0.001). Conclusions: The prognosis for a member of the abutting or the positive CRM group was more unfavorable than it was for a member of the negative CRM group; therefore, measurement of the CRM should be reported in the pathologic report. For patients with an abutting or a positive CRM, neoadjuvant or adjuvant chemoradiotherapy should be considered for better oncologic outcomes.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
5. Research Institutes (연구소) > Cancer Metastasis Research Center (암전이연구센터) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Hogeun(김호근)
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Sohn, Seung Kook(손승국)
Lee, Kang Young(이강영)
Chung, Hyun Cheol(정현철) ORCID logo https://orcid.org/0000-0002-0920-9471
Cho, Chang Hwan(조장환)
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