A Study on Distal Intramural Tumor Spread in Rectal Cancer.

概要

論文の詳細を見る
Two hundred and ninety-seven rectal cancer specimens were examined retrospectively for microscopic distal intramural tumor spread (DIS). DIS was revealed in 67 cases [DIS (+): 23%]. Among those, 58 showed DIS of 2 cm or less, whereas 9 showed DIS of longer than 2 cm. The maximum DIS was 3.7 cm. DIS (+) cases showed a wrse surgical outcome than those without DIS [DIS (-)]. The curative resection rate was only 34% in DIS (+) cases, whereas it was 77% in DIS (-) cases. The tumor recurrence rate was higher and the cumulative 5-year survival rate was lower in DIS (+) cases than DIS (-) cases (57% vs 25%, p<0.005; 36% vs 74%, p<0.001, respectively). On pathological study of these rectal tumors, four characteristics were identified as risk factors for DIS of longer than 2cm: 1) ulceration and an ill-defined border; 2) poorly differentiated type or signet-ring cell type; 3) a diameter of longer than 6 cm; 4) annular or semiannular shape. Patients with one or no risk factors had no DIS of longer than 2 cm, whereas the rate of DIS of longer than 2cm in the patients with 2 or more risk factors was 11% (p<0.005). It is concluded that a distal surgical margin of 4cm should be left for rectal cancer with 2 or more risk factors, while 2 cm might be enough for cancer with one or no risk factors.
一般社団法人日本消化器外科学会の論文