원위부 직장암에서 시행된 초저위전방절제술 및 대장항문문합술; 수술 및 종양학적 안전성

Abstract

Purpose: Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer. Methods: Forty-eight patients underwent coloanal anastomosis following untralow anterior resection between january 1988 and january 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences. Results: Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage(N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean Frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3months, 1.8 at 1 year and 1.5 at 2 years. Conclusions: With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.(JKSCP2000;16:334-338)