대한대장항문학회

Purpose : Total mesorectal excision has been advocated as the effective operation for<br>patients with rectal cancer to reduce the local recurrence rate after curative resection. Its<br>rationale is to remove possible tumor foci at the mesorectum distal to the level of the rectal<br>cancer. This study was undertaken to clarify the rationale for total mesorectal excision.<br>Methods : Total mesorectal excision was performed in 72 patients with rectal cancer who<br>admitted in Severance Hospital between December, 1996 and December, 1997. The obtained<br>mesorectums were classified to M0 (from the proximal margin to the distal margin of the<br>tumor), M1 (from the distal margin to 2 cm below the distal margin), M2 (from 2 cm to 5 cm<br>below the distal margin), and microscopic examination was done. Results : The nodal<br>metastases were detected in 7 cases and tumor deposits in 4 cases. Especially in M2 with<br>Dukes' C2, the rate of nodal metastases was 3.6 percent and the rate of tumor deposits was<br>7.1 percent. The nodal metastases and tumor deposits in the distal mesorectum have no<br>correlation with gross finding, size, location and differentiation of the tumor. Conclusions : En<br>bloc excision of all mesorectal tissue down to at least 5 cm below the lower margin of the<br>tumor is required for patients with advanced rectal cancer to remove possible metastatic<br>lymph nodes and tumor deposits in the distal mesorectum.<br>