대한대장항문학회

Gastrointestinal smooth muscle tumors are known for their wide variability in clinical<br>behavior and for the difficulty inherent in determining malignancy. The lack of reliable<br>criteria for malignancy and the marked tendency of these tumors to recur are two main<br>problems the surgeon faces when selecting the operative procedure to be used. Because<br>of the rarity of this tumors especially located in lower rectum and anus, the most<br>effacious therapeutic approach has not been determined. In this regard we retrieved 35<br>cases of smooth muscle tumors arising from small and large bowel which had<br>undergone laparotomy at the Department of Surgery, Seoul National University Hospital<br>during 17 years period from 1973 to 1990 with an emphasis on clinical pictures and<br>treatment methods with review of literatures. There were leiomyoma in 12 cases and<br>leiomyosarcoma in 23 cases among 35 patients. The sites of leiomyoma were small<br>intestine in 6(50%), colon in 3(25％) and rectum in 3(25%). The sites of leiomyosarcoma<br>were small intestine in 12(52%), colon in 3(13%), rectum in 6(26%) and anus in 2(9％).<br>The Presenting symptoms and signs on admission were abdominal pain in most cases,<br>palpable abdominal mass, melons, intestinal obstruction, bowel habit change in decreasing<br>order of frequency. The operative procedure performed were low anterior resection for<br>the leiomyoma, which was located in 5,6,8cm above from anal verge respectively In case<br>of leiomyosarcoma Miles' operation was done in 3 cases due to large mass and frequent<br>mitosis (5∼10>10HPF), which was located 3, 4, 7cm above from anal verge respectively<br>and pelvic exenteration were done in 2 cases due to bladder invasion. On the other hand<br>wide local excision was done in anal leiomyosarcoma due to reluctancy of anal sacrifice<br>but the mass was recurred at it's original sites 6 month later, and Miles' operation was<br>done afterward.<br>Some authors suggested wide local excision at selected patients (old age, size<2 cm,<br>low grade malignancy) but with above results and results of references we might<br>conclude that standard surgical approach for tumors in the lower rectum and anal lesion<br>is APR, even though it is undetermined malignancy.<br>