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直腸癌肛門温存手術の適応に関する検討

Research Project

Project/Area Number 17591426
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeSingle-year Grants
Section一般
Research Field Digestive surgery
Research InstitutionShizuoka Cancer Center

Principal Investigator

SAITO Shuji  Shizuoka Cancer Center, Researcher (80347319)

Co-Investigator(Kenkyū-buntansha) ISHII Masayuki  Shizuoka Cancer Center, Research Institute, Researcher (60443446)
SHOICHI Fujii  Yokohama City Univ.Sch.of Med., 大学附属病院, Associate Professor (70326065)
YAMAGISHI Shigeru  Yokohama City Univ.Sch.of Med., 医学部, Assistant (20404973)
OTA Mitsuyoshi  Yokohama City Univ.Sch.of Med., 大学附属病院, Assistant (60315794)
Project Period (FY) 2005 – 2007
Project Status Completed (Fiscal Year 2007)
Budget Amount *help
¥3,150,000 (Direct Cost: ¥3,000,000、Indirect Cost: ¥150,000)
Fiscal Year 2007: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
Fiscal Year 2006: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 2005: ¥2,000,000 (Direct Cost: ¥2,000,000)
KeywordsSurgery / Pathology / Rectal cancer / Sphincter preservation
Research Abstract

1) Vertical Spread to Levator and External Sphincter of Low Rectal Cancer
Background : 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

Report

(4 results)
  • 2007 Annual Research Report   Final Research Report Summary
  • 2006 Annual Research Report
  • 2005 Annual Research Report
  • Research Products

    (6 results)

All 2009 2007 2006

All Journal Article (2 results) Presentation (4 results)

  • [Journal Article] 外肛門括約筋に浸潤あるいは近接する直腸癌の術前MRI診断2006

    • Author(s)
      石井正之, 齊藤修治, ほか
    • Journal Title

      日本大腸肛門病学会雑誌 第59巻・7号

      Pages: 367-372

    • NAID

      10018260527

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Journal Article] 外肛門括約筋に浸潤あるいは近接する直腸癌の術前MRI診断2006

    • Author(s)
      石井正之, 齊等修治, ほか
    • Journal Title

      日本大腸肛門病学会雑誌 第59巻・7号

      Pages: 367-372

    • NAID

      10018260527

    • Related Report
      2006 Annual Research Report
  • [Presentation] 直腸癌切断標本の病理学的検討からみたISRの適応と手技2009

    • Author(s)
      成井一隆
    • Organizer
      第64回 日本消化器外科学会総会
    • Place of Presentation
      大阪
    • Year and Date
      2009-07-18
    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Presentation] 下部直腸癌に対するIntersphincteric resectionの適応と短期成績2007

    • Author(s)
      富岡寛行
    • Organizer
      第107回 日本外科学会定期学術集会
    • Place of Presentation
      大阪
    • Year and Date
      2007-04-11
    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Annual Research Report 2007 Final Research Report Summary
  • [Presentation] 病理組織学的検討からみた下部直腸癌に対するISRの適応2006

    • Author(s)
      成井一隆
    • Organizer
      第68回 日本臨床外科学会総会
    • Place of Presentation
      広島
    • Year and Date
      2006-11-11
    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Presentation] 病理組織学的検討からみた下部直腸癌に対するISRの適応2006

    • Author(s)
      成井一隆
    • Organizer
      第61回 日本大腸肛門病学会総会
    • Place of Presentation
      弘前
    • Year and Date
      2006-09-30
    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary

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Published: 2005-04-01   Modified: 2016-04-21  

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