下部直腸癌，こう門管癌に対する括約筋切除をともなう新しいこう門温存術の可能性―病理組織学的研究―

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  • Possibility of New Anus Preserving Operation with Sphincter Resection for Carcinoma of Lower Rectum or Anal Canal-Histological Study-
  • Histological Study
  • 病理組織学的研究

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The possibility of a new sphincter saving operation for carcinoma of the lower rectum or anal canal was examined.<BR>Materials and methods : The presence or absence of invasion and metastasis to the anal canal was histologically reviewed based on 211 surgical specimens of abdominoperineal resection. The location was classified into Pa cancer (lower edge of tumor was above the dentate line : 176 cases) and Pb cancer (lower edge of tumor was below the dentate line : 35 cases). In the Pa cancer, invasion and/or metastasis to the deepsuperficial sphincter muscles was 11.3 %, and invasion and/or metastasis to the subcutaneous sphincter muscle was 1.1%. These were extremely low rates and the depth of invasion (DI) was al or more in all cases. In the Pb cancer, the values were 37% and 9%, respectively. The DI was also al or more in all cases. Invasion and/or metastasis to the intermuscular groove was 2.3% in the Pa cancer, and 29% in the Pb cancer.<BR>Conclusion : When the DI is within the proper muscle, anus preservation is feasible by keeping all external sphincter muscles. When the DI is beyond the proper muscle, anus preservation is feasible only by keeping the subcutaneous sphincter muscle, but is impossible if the Pa or Pb cancer invades the intermuscular groove.

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