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直腸癌肛門温存手術の適応に関する検討

直肠癌保肛手术指征的考虑

基本信息

批准号：
17591426
负责人：
SAITO Shuji
金额：
$ 2.02万
依托单位：
Shizuoka Cancer Center
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2005
资助国家：
日本
起止时间：
2005 至 2007
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-17591426/
关键词：
Surgery Pathology Rectal cancer Sphincter preservation

项目摘要

1) Vertical Spread to Levator and External Sphincter of Low Rectal CancerBackground : Intersphincteric resection (ISR) enables us to obtain a certain extent of distal margin and preserve sphincter function. But, there were still little data of how low rectal cancers spread into anal canal. In the anal canal, levator and external sphincter are striated muscle, surface of which should be the surgical margin of ISR. Thus far, vertical spread of low rectal cancer to this striated muscle has little been studied.Objectives : The aim of this study is to evaluate vertical spread of low rectal cancer and to determine unfavorable factors that shorten distance between cancer and striated muscle (levator and external sphincter) as to undergo ISR with more appropriate patient selection.Materials and Methods : We conducted the specimen resected by rectal amputation from 53 patients, having T2-3 tumor and the lower edge of the tumor was within 2cm from the dentate line or invading beyond dentate line … More . They were composed of 36 males and 17 females with a mean age of 61.5±10.4 years at operation (range, 32-82 years). No patients received preoperative adjuvant therapy. We assessed both vertical spread and distal spread of the tumor. Vertical spread to striated muscle (levator or external sphincter) was estimated by measuring the shortest distance between the tumor and the striated muscle (T-SM distance). We also assessed how cancer spreads close to striated muscle (levator or external sphincter).Results : Distal spread was observed with 15 specimens. Length of distal spread in the 15 specimens was 4.2±3.0 millimeters (range, 1-10 millimeters). Mean distance between the tumor and the striated muscle (T-SM distance) was 9.1±7.2 millimeters (range, 0-32 millimeters). According to univariate analysis of risk factor shortening T-SM distance, predominant histological type excepting well or moderately differentiated adenocarcinoma, short T-DL distance and distal spread are the factor shortening T-SM distance. According to multivariate analysis, T-DL distance and distal spread is independent factor of short T-SM distance, whether the short distance is 2 millimeters or 5 millimeters. As to invading patterns of cancer to striated muscle, distance between cancer and the striated muscle were shorter in the deep part of external sphincter than the superficial part in most cases.Conclusion : Indication of ISR to advanced low rectal cancers should be limited to that lower edge was oral to dentate line and was not accompanied by distal spread. Anal manipulation during ISR should be performed from abdominal procedure prior to anal procedure. Less

1)低位直肠癌垂直向提肌和外括约肌的转移背景：括约肌间切除术（ISR）使我们能够获得一定程度的远端切缘并保留括约肌功能。但是，关于低位直肠癌如何扩散到肛管的数据仍然很少。肛管内的提肌和外括约肌均为横纹肌，其表面应为ISR的手术切缘。目的：本研究的目的是评估低位直肠癌的垂直扩散，并确定缩短癌与横纹肌之间距离的不利因素（提上肌和外括约肌）作为进行ISR的更合适的患者选择。材料和方法：我们对53例T2-3肿瘤患者行直肠切除术，肿瘤下缘距齿状线2cm以内或侵犯齿状线以外 ...更多信息 .其中男36例，女17例，手术时年龄32-82岁，平均61.5±10.4岁。无患者接受术前辅助治疗。我们评估了肿瘤的垂直扩散和远端扩散。通过测量肿瘤和横纹肌之间的最短距离（T-SM距离）来估计垂直扩散到横纹肌（提肌或外括约肌）。我们还评估了癌细胞如何扩散到横纹肌（提肌或外括约肌）。15个样本的远端扩展长度为4.2±3.0 mm（范围：1-10 mm）。肿瘤与横纹肌之间的平均距离（T-SM距离）为9.1±7.2 mm（范围，0-32 mm）。T-SM距离缩短的危险因素单因素分析显示，除高、中分化腺癌外，T-DL距离短和远端扩散是T-SM距离缩短的主要因素。根据多变量分析，无论T-SM距离是2 mm还是5 mm，T-DL距离和远端扩展是T-SM距离短的独立因素。外括约肌深部肿瘤与横纹肌的距离大多短于浅表。结论：进展期低位直肠癌的ISR指征应局限于下缘为口腔至齿状线，不伴远端扩散。ISR期间的肛门操作应在肛门手术前从腹部手术开始。少