Surgery of Cancer of the Large Bowel
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概要
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Remarks are first made on various items necessary for surgery of cancer of the large bowel. Detection of early cancer is only around 10% in the case of cancer in the large bowel. But recent progress in diagnosis especially of endoscopic biopsy, has revealed that majority of cancer in the large bowel originates from adenoma. Further, most of the early cancer take polypoid appearance and can now be cured easily by endoscopic polypectomy.<BR>In the surgery of colon cancer, it has become relatively easy to carry out wide resection of the colon and complete dissection of the lymph nodes. The rate of curative operation is as high as 80 %, and non-touch isolation technique (Turnbull) is also carried out to prevent hematogenic spread of cancer cells. For reconstruction of the intestine, end-to-end anasto-mosis is employed exclusively.<BR>For cancer in the lower rectum, abdomino-perineal amputation is used. For the prevention of local recurrence, which occurs in a relatively large number, wide removal of the rectum and anus, and complete dissection of regional lymph nodes are being carried out in recent years. Although it is somewhat complex, dissection of lymph nodes along the internal iliac vessels should not be overlooked. In spite of extended surgical technique, operative wound undergoes rapid primary healing.<BR>For cancer in the upper rectum, sphincter-peserving operation is carried out. This operation has become safe by the progress in surgical technique, and radicality can be fully satisfied. In cancer of the upper rectum, the low anterior resection is better. If the lower margin of the tumor is a little low and within 4-5 cm above the dentate line, the pull-through operation will be indicated. This sphincter-preserving technique is now used in 40 % of operated rectal cancer cases together with progress in the diagnosis of rectal cancer.<BR>Thus, the treatment of rectal cancer is being developed, with prevention of local recurrence by extended surgery in cancer of the lower rectum and by preservation of anal functions without loss of radicality in cancer of the upper rectum.<BR>Majority of cancer of the large bowel are localized type, the rate of metastasis to lymph nodes is low, and the end results are generally favorable. Five-year survival rates in cases undergoing curative operation have been 69% for colon carcinoma and 58% for rectal carcinoma.
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