조기대장암의 내시경을 이용한 치료
Endoscopic therapy of early colon cancer
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참고문헌
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초록
우리나라에서도 선진국형 암이라고 할 수 있는 대장암이 급속히 증가하고 있다. 특히, 선별대장내시경이 도입되면서 과거에 비해 초기의 대장종양 즉, 양성 대장폴립 및 조기대장암의 진단이 증가할 것으로 생각된다. 따라서 조기대장암에 대한 임상의사의 관심이 요구되는 시점이라 할 수 있다. 전이가 없는 조기대장암은 원발종양에 대한 완전절제 즉, 내시경절제술을 통해 완치를 기대할 수 있다. 그러므로, 조기 대장암이 의심되는 경우, 세심하고 다양한 내시경 관찰법을 통해 림프절 전이의 위험도를 예상하고, 림프절 전이 위험도가 낮다고 판단되는 경우에 내시경절제술을 시행해야 한다. 조기대장암은 충분한 절제변연을 확보한 채 일괄절제하는 것이 중요하므로 병변의 모양 및 크기에 따라 다양한 내시경절제술 기법들 중 적절한 방법을 선택해야 한다. 한편, 절제 후에는 절제된 조직의 정확한 병리 검토를 통해 림프절전이 위험도를 한번 더 판정하고, 이를 바탕으로 추가 외과 수술의 필요성을 결정해야 한다. 최근 많은 연구 결과들이 발표되고 있는 NOTES (natural orifice transluminal endoscopic surgery) 등의 발전과 함께 보다 효과적인 조기대장암 치료 지침이 마련될 미래를 기대해 본다.
Abstract
The detection of early colon cancer has increased since the advent of screening colonoscopy. Endoscopic resection can be performed to cure early colon cancer with no metastasis. Therefore, we should correctly predict the possibility of metastasis before a trial of endoscopic resection. Metastasis may be assessed using chromoscopy with magnification, narrow band imaging, and endoscopic ultrasound, as well as with conventional imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI). Various endoscopic resection techniques, including endoscopic submucosal dissection, can be performed to resect early colon cancer. The histopathological evaluation of endoscopically resected early colon cancer can provide clinicians with further information about the risk of regional lymph node metastasis. The decision to perform additional surgery is based on the histopathological examination of the resected specimens.
참고문헌 (30)
- 大腸癌硏究會, "大腸癌取扱ぃ規約. 第6版" (1998), 金原出版株式會社
- Fenoglio CM, "Distribution of human colonic lymphatics in normal, hyperplastic, and adenomatous tissue: its relationship to metastasis from small carcinomas in pedunculated adenomas, with two case reports", Gastroenterology, 64, pp.51~66 (1973)
- Eckardt VF, "Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma: compliance, recurrence, and survival", Cancer, 61, pp.2552~2557 (1988)
- Tung SY, "Clinical outcome of endoscopically removed early colorectal cancer", J Gastroenterol Hepatol, 18, pp.1175~1179 (2003)
- 정성애, "대장 점막하 침윤 림프절 전이의 위험인자: 심달도 분류를 중심으로", 대한소화기내시경학회지, 22, pp.411~418 (2001)
- Park YJ, "Histoclinical analysis of early colorectal cancer", World J Surg, 24, pp.1029~1035 (2000)
- Shimomura T, "New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion", J Gastroenterol Hepatol, 19, pp.48~55 (2004)
- Lee BI, "Early colon cancer: keys for initial therapeutic plan", Intest Res, 7(Suppl 2), pp.33~38 (2009)
- Zerhouni EA, "CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II", Radiology, 200, pp.443~451 (1996)
- Matsumoto T, "Comparison of EUS and magnifying colonoscopy for assessment of small colorectal cancers", Gastrointest Endosc, 56, pp.354~360 (2002)
- Kitajima K, "Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study", J Gastroenterol, 39, pp.534~543 (2004)
- 양석균, "대장내시경 진단 및 치료. 제2판" (2009), 군자출판사
- Kanao H, "Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors", Gastrointest Endosc, 69, pp.631~636 (2009)
- Higaki S, "Long-term follow-up of large flat colorectal tumors resected endoscopically", Endoscopy, 35, pp.845~849 (2003)
- Tanaka S, "Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm", Gastrointest Endosc, 54, pp.62~66 (2001)
- Kim HY, "Usefulness of follow-up colonoscopy in laterally spreading tumor resected by endoscopic piecemeal mucosal resection", Intest Res, 2, pp.186~191 (2003)
- Su MY, "Endoscopic mucosal resection for colonic non-polypoid neoplasms", Am J Gastroenterol, 100, pp.2174~2179 (2005)
- 鶴田, "早期大腸癌の內視鏡治療の適應と限界. In: 早期大腸癌內視鏡 ハソドブシク", pp.152~156 (1997), 中外醫學社
- 齊裕輔, "粘膜切除術-結節集簇樣大腸病變 の治療. In:早期大腸癌內視鏡 ハソドブシク", pp.174~177 (1997), 中外醫學社
- 大腸癌硏究會, "大腸癌治療ガイドテイソ. 2005年版" (2005), 金原出版株式會社
- 정기욱, "직장감각저하 환자에서 바이오피드백 치료에 대한 장기간 효과 및 인자 분석", Intestinal research, 6(1), pp.56~59 (2008), 대한장연구학회
- Yamamoto H, "Mucosectomy in the colon with endoscopic submucosal dissection", Endoscopy, 37, pp.764~768 (2005)
- Yamamoto H, "Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood", Endoscopy, 35, pp.690~694 (2003)
- Yamamoto H, "Endoscopic submucosal dissection using sodium hyaluronate for large superficial tumors in the colon", Dig Endosc, 16, pp.178~181 (2004)
- Tanaka S, "Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection", J Gastroenterol, 43, pp.641~651 (2008)
- Saito Y, "A new sinker-assisted endoscopic submucosal dissection for colorectal cancer", Gastrointest Endosc, 62, pp.297~301 (2005)
- Sakamoto N, "Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video)", Gastrointest Endosc, 69, pp.1370~1374 (2009)
- Fujishiro M, "Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of highmolecular- weight hyaluronic acid, glycerin, and sugar", Gastrointest Endosc, 63, pp.243~249 (2006)
- Saito Y, "A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation", Gastrointest Endosc, 65, pp.537~542 (2007)
- Bond JH, "Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology", Am J Gastroenterol, 95, pp.3053~3063 (2000)