일측성 하악과 골절치료의 수술적 방법과 비수술적 방법에 대한 임상적 고찰

김양우,차진한 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.2

Mandibular condyle fracture, as common as it may be still has many controversies in its treatment. Other mandibular fractures are usually treated by surgical procedures, however unilateral mandibular condyle fracture is frequently treated by intermaxillary fixation. However, with such conservative method about 30% have reported failure in mandibular functions. Recently, surgical methods have reported good results for normal anatomical reconstruction of mandibular condyle fracture. We treated 56 unilateral mandibular fracture patients from March, 1988 to August, 1995, of these 41 were treated conservatively and the remaining 15 were treated by open reduction. Their pre- & post-treatment X-rays and physical findings were analyzed and followed up to obtain the following data. 1. Of 56 patients, 39 were male and 17 were female. All five patients with intracapsular fracture were all conservatively treated, 17 of the 21 patients with condylar neck fracture were treated conservatively and the remaining 4 were surgically treated. Eleven of the 30 patients with subcondylar fracture were treated surgically. 2. Under radiological examination, 41 patients who underwent conservative treatment showed no significant improvement in displacement angulation. However, in 15 patients who were surgically treated showed significant decrease in displacement angulation from 67˚pretreated to 7˚post-treated. 3. Under radiological examination, nonsurgical group showed no significant improvement in reduction of mandibular height. Surgical group showed statistically significant improvement from 16mm to 2mm. 4. Condylar neck fracture showed improvement in displacement from 29˚ to 25˚with conservative treatment alone, however subcondylar fracture failed to show improvement with conservative treatment alone. On the other hand, in the surgical group both condylar neck and subcondylar fracture showed significant improvement in displacement angulation. 5. In condylar neck fracture, both nonsurgical and surgical group showed similar mouth opening state. In subcondylar fracture only the surgical group showed similar mouth opening state. In subcondylar fracture only the surgical group showed significant improvement of mouth opening state. 6. Nonsurgical group showed higher incidence of malocclusion, mandibular asymmetry, pain, and clicking sounds in the joints compared to surgical group. On the other hand, surgical group developed a transient facial paralysis which was recovered about 3 weeks post-surgery. In conclusion, even with severe malocclsion, displacement angulation or reduction in mandibular height surgical group showed better improvement as compared to nonsurgical group. Also other subjective symptoms that the patients feel or the objective clinical evaluations show that surgical group had better results than the nonsurgical group. Especially, in the case with subcondylar fracture surgical group showed better improvement in many ways compared to the nonsurgical group.

Usability of Surgical Treatment of Stage Ⅱ Medication Related Osteonecrosis of the Jaw

황대석,송재민,유미현,최나래 대한구강악안면병리학회 2019 대한구강악안면병리학회지 Vol.43 No.1

This study was planned to evaluate the efficacy of surgical treatment in stage 2 medication related osteonecrosis of jaw(MRONJ) patients. Retrospective analysis was performed about patients who were treated with medication related osteonecrosis of jaw from 2015 to 2017. 25 Patients were treated by a single surgeon at the Department of Oral Surgery, Dental Hospital, Pusan National University. The treatment methods they received were conservative or surgical. The results of treatment were classified as "fail" and "success" and the prognosis according to the treatment method was compared. Conservative treatment 14.29% (2 cases), sequestrectomy 64.29% (9 cases) and saucerization 21.43% (3 cases) were performed in the MRONJ group, and 2 treatment failures were encountered after conservative treatment and 1 after saucerization. Surgical treatment resulted in better outcomes in stage 2 MRONJ patients. Furthermore, treatments were deemed successful when surrounding necrotic bone containing sequestrum was reliably removed. Therefore, this study suggests that the treatment of "stage 2" MRONJ should actively consider surgical treatment.

자궁근종으로 진단된 환자의 치료 선호도 및 치료방법에 관한 고찰

조수희 ( Soo Hee Jo ),김주명 ( Joo Myung Kim ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김미라 ( Mi La Kim ),최규홍 ( Kyu Hong Choi ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ),주관영 ( Kwan Young Joo ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

목적: 외래 내원 환자 중 자궁근종을 가진 환자의 치료 방법에 대한 선호도를 확인하고, 진단 이후의 치료방법에 대해 알아보고자 하였다. 방법: 2006년 1월 1일부터 12월 31일까지 외래를 내원한 환자 중 초음파상 자궁근종으로 진단된 577명의 환자를 대상으로, 진단 후 치료방법에 대해 후향적으로 의무기록을 확인하였다. 또한, 외래 초진시 근종으로 진단받은 환자 100명에서의 치료 방법에 대한 설문지 선호도 조사 자료를 분석하였다. 결과: 자궁근종을 가진 환자에서 가장 흔하게 나타나는 증상은 통증으로 58.6%에서, 출혈과 관련된 증상은 51.3%, 압박증상은 30.2%에서 보였다. 특별한 약물치료 없이 정기적 추적관찰은 31.7%의 환자에서 시행되었으며, NSAID와 같은 비호르몬제 약물은 27.1%에서, 미레나를 포함한 호르몬제는 41.9%에서 사용되었다. 수술을 시행받은 환자는 총 182명으로 31.5%에서 시행되었으며, 그 중 104명은 자궁근종절제술을 시행받았으며, 아전자궁적출술은 36명, 전자궁적출술은 42명에서 시행되었다. 출혈관련 증상을 가진 환자의 42.6%, 통증관련은 34.6%, 압박증상 관련은 50.6%에서 수술을 시행하였다. 근종으로 진단된 초진 환자 100명을 대상으로 한 설문지 조사에서는 우선적으로 약물치료를 원하는 환자가 78명, 수술적 치료를 원하는 환자가 22명이었다. 수술을 시행받아야 한다면 우선적으로 근종절제술을 시행받기를 원한 환자가 94명, 자궁적출술을 받기를 원한 환자는 6명이었다. 결론: 출혈이나 통증과 관련된 증상을 가진 자궁근종 환자에서는 일차적으로 약물치료가 효과적이며, 환자의 선호도 역시 비침습적인 약물치료를 우선 시행받는 것을 원하는 것으로 나타났다. Objective: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. Methods: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients` characteristics, treatment methods and questionnaires for patient preference were evaluated. Results: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. Conclusions: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.

경골 간부 골절에서 족관절 손상에 대한 수술적 치료의 비교 연구

박진호,이승진,이효범,김갑래,장지우,함희범 대한족부족관절학회 2023 대한족부족관절학회지 Vol.27 No.3

Purpose: Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postop- erative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of con- comitant ankle injuries associated with tibial shaft fractures. Materials and Methods: From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the ortho- pedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), mag- netic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson–Peterson ankle score (KP score). Results: Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group. Conclusion: Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia frac- tures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.

고혈압성 뇌실질내출혈의 장기추적결과의 평가 : 외과적 및 보존적 치료의 비교연구 A Comparative Study of Surgical and Conservative Treatment in 1009 Cases

임영진,이기홍,김태성,김국기,이봉암,임언 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.8-9

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time : or 3) lack of proper classification of hematomas for comparison of results from different institutions. The author analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical centre for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ratio was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhages had brought about a high incidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade Ⅰ-Ⅱ, and also decreased the frequency of Grade Ⅲ. but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.

폐쇄성 수면 무호흡증의 외과적 치료

송승일(Seung Il Song),이호경(Ho Kyung Lee) 대한치과의사협회 2014 대한치과의사협회지 Vol.52 No.10

폐쇄성 수면 무호흡증(OSAS)환자의 외과적 치료(surgical treatment)로는 다양한 방법들이 있고 수술 방법의 선택시 여러 인자들을 고려해서 선택해야 한다. 즉, 수술은 폐쇄성 수면 무호흡증(OSAS)을 조절하는데 있어 보존적 치료 (non surgical treatment)의 좋은 대체 방안(alternative chance)이 될 수 있기에, 증상(OSAS)의 주관적(subjective), 객관적(objective) 심각성(severity)을 해부학적 이상(anatomic abnormality) 정도와 연관시켜 적절한 수술법(surgical procedure)을 선택해야 한다. 수술 방법은 한가지 방법을 사용(single level)하는지, 여러 수술 방법을 통합하여 사용(multi level)하는지에 따라 다양하며, 그 예후도 각각 다르다. 중요한 점은 다단계 폐색(multilevel obstruction)이 있는 경우에는 다단계 치료(multilevel treatment) 방법이 가장 추천된다는 것이며, 이는 단지 증상(OSAS)의 심각성(severity)을 기준으로만 평가해서는 안되며 경도나 중등도(mild to moderate)의 환자에서도 필요시 보존적 치료(non surgical treatment)를 시행하기 전에 다단계 외과적 치료(multilevel surgical treatment) 방법을 적극적으로 고려해야 한다. 비록 다단계 치료(multilevel treatment)방법은 상대적으로 짧은 임상 기간을 거쳤지만, 앞으로 지속적인 연구 결과(evidence based data)를 이어간다면, 개개 환자에 맞는 최적의 치료 방법(optimal surgical intervention)을 제시할 수 있을 것이다. Obstructive sleep apnea syndrom(OSAS) is defined by total or partial collapse of the upper airway during sleep. In the presence of specific anatomic features, OSAS is potentially amenable to surgical treatment. Initially, the only treatment available for these patients was a tracheotomy that bypassed the obstruction and resulted in a 100% cure. However, this was not readily accepted by most patients, and surgical methods other than tracheotomy were developed to successfully maintain adequate upper airway patency during sleep by comparing to postoperative polysomnography(AHI,RDI etc). In this paper, I would like to provide an overview of some of the multilevel surgical techniques available for treating OSAS as well as the necessary preoperative considerations.

코골이 및 폐쇄성 수면 무호흡증의 외과적 처치에 대한 임상적 연구

이용권(Yong-Kwon Lee),명훈(Hoon Myung),황순정(Soon-Jung Hwang),서병무(Byoung-Moo Seo),이종호(Jong-Ho Lee),정필훈(Pill-Hoon Choung),김명진(Myung-Jin Kim),최진영(Jin-Young Choi) 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.4

Purpose: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. Methods and materials: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7 (M : F = 5 : 2 , mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. Results: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. Conclusion: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.

한의학적 치료로 호전된 안면비대칭 5례

신정민,안진향,이진혁 대한한의학회 2019 대한한의학회지 Vol.40 No.3

Objectives: The purpose of this study was to investigate the effect of Korean medicine treatment on facial asymmetric treatment in 5 cases of facial asymmetry correction by non - surgical treatment such as acupucture, chuna treatment , FCST (Functional cerebrospinal technique) and cranial osteopathy. Methods: We analyzed the initial charts of 5 patients who had undergone facial asymmetry in a Korean medicine clinic and measured the position and distance using the photograph, lateral cephalograms, and whole body radiograms. The results were as follows. Results: To quantify both soft and hard tissues to confirm the results of Korean medicine treatment of facial asymmetry, soft tissues quantitatively measure the displacement of the face, the slope of the left and right eyes, and the slope of the lip in order to grasp the positional displacement of the mandible. As a result, on the average, the correction effect as measured by the angle difference between A and C is 1.8±0.57, the correction effect as measured by the angle difference between B and C is 1.4±0.89, and the angle difference between D and the horizontal plane is 1.9±0.89, and the angle difference between E and the horizontal plane is 1.9±0.89. The result of reduced angle difference between A and C means that the head position shifted from the center of the body to the unilateral side was shifted to the center. The decrease in the angle difference between B and C means the restoration of the maxillary distortion relative to the mandible. In hard tissues, numerical values ​​were measured based on the skull standard. The average distortion of the skull was 1.9±0.67, and the distortion of the lower eye was 1.4±0.41. Conclusion: General studies on facial asymmetric treatment are limited to treatments such as surgery and orthodontics. However, this study confirmed the possibility that facial asymmetry could be corrected by Korean medical treatment consisting of reversible non-surgical treatment rather than irreversible treatment such as surgery or orthodontic treatment. In particular, Korean medicine treatment is effective for muscular asymmetry, soft asymmetry, functional asymmetry, etc. The facial asymmetric treatment of Korean medicine is not limited to the face-centered correction, but the asymmetry of the whole body may be corrected as well.

요추부 퇴행성 시상면 불균형 환자에서의 수술적 치료 후 근위 인접 분절의 문제와 연관된 위험 인자

김환정,송대건,강종원,박건영,구제윤,권원조,최원식,이재원 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.4

Study Design: Retrospective study. Objectives: As we analyze the incidence and the risk factor for proximal junctional problem after surgical treatment of lumbar degenerative sagittal imbalance, we want to contribute to reducing the junctional problem of surgical treatment of lumbar degenerative sagittal imbalance. Summary of Literature Review: Surgical treatment of degenerative spinal deformity has increased. Rigid fixation was a risk factor for degenerative change of adjacent segment and failure, and it remains a big challenge for the junctional problem of surgical treatment. However, research on the correlation with risk factors is rare. Materials and Methods: Forty four patients (mean age 66.5; range, 50-74) who had surgery due to lumbar degenerative sagittal imbalance were evaluated by the risk factor associated with junctional problems from January, 2005 to December, 2011. The risk factors were analyzed by surgical factor (proximal fusion level, using iliac screw, correction or undercorrection of lumbar lordosis compared with pelvic incidence) and patient factor (age, bone marrow density, body mass index). Results: Junctional problems occurred in 18 patients (41%) out of 44 patients. Among these problems, there were 10 cases of fractures, 8 cases of junctional kyphosis, and 4 cases of proximal screw pull out. . Among the risk factors, only the correction or undercorrection of lumbar lordosis compared with pelvic incidence in surgical factor was statistically significant. Other surgical factors and patient factors were not statistically significant. Conclusions: Junctional problems after a surgical treatment of lumbar degenerative sagittal imbalance were common. However, we could not know the exact risk factor of junctional problems except the degree of correction of lumbar lordosis compared with pelvic incidence, because most of the risk factors were not statistically significant. So, further evaluations of the risk factor of lumbar degenerative sagittal imbalance are required. 연구 계획: 후향적 연구. 목적: 요추부 퇴행성 시상면 불균형으로 수술 후 발생하는 인접 분절 문제의 발생 빈도, 인접 분절 문제 발생에 영향을 주는 위험 요소와 연관성을 분석하여 요추부 퇴행성 시상면 불균형 환자의 수술적 치료에서 발생하는 근위 인접 분절의 합병증을 줄이는데 기여하고자 한다. 선행문헌의 요약: 요추부 퇴행성 척추 변형에 대한 수술이 증가하고 있다. 성공적인 유합술은 인접 분절의 퇴행성 변화와 실패의 위험인자가 되며 수술적 치료 후 발생하는 인접 분절에서의 문제들은 가장 큰 과제로 남아있으나 그 위험 요소에 대한 분석은 부족한 실정이다. 대상 및 방법: 2005년 1월부터 2011년 12월까지 요추부 퇴행성 시상면 불균형으로 수술을 시행 받은 44명의 환자를 대상 (평균 65.8세, 범위 50~74세)으로 하여 인접 분절의 문제에 대하여 각각 위험 요소와의 관련성을 분석하였다. 위험 요소는 수술적 요인 (근위 유합 부위, 장골 나사의 사용 유무, 골반입사각 대비 요추 전만각 교정 여부) 와 환자 요인 (나이, 골밀도, 체질량 지수)로 나누어 분석하였다. 결과: 총 44예의 환자 중 18명의 환자 (41%)에서 인접 분절 문제가 발생하였다. 인접 분절 문제 중 골절 10예, 분절 후만 8예, 근위 나사 이완 4예였으며위험 요소로서 수술적 요인 중 골반 입사각 대비 요추 전만각 교정 여부는 통계적 유의성을 보였으나 다른 수술적 요인과 환자 요인에서는 통계적인 유의성이 없었다. 결론: 요추부 퇴행성 시상면 불균형 환자의 수술적 치료 시 근위 인접 분절 문제가 비교적 흔하게 발생하였으나 분석 요인들 중 골반 입사각 대비 요추전만각 교정 여부를 제외 하고는 대부분 통계적 유의성을 보이지 않아 근위 인접 분절 문제의 정확한 위험 요소를 알기는 힘들었으며 이에 대한 추가적인 연구가 필요할 것으로 생각된다.

중 하부 직장암의 수술적 치료에 대한 종양학적 고찰

김남규(Nam Kyu Kim) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1

Updates and Debate issues form the surgical treatment of middle or low rectal cancer The main goals for the surgical treatment of rectal cancer were the complete removal of the rectal cancer with surrounding lymphatic draining area, which subsequently result in decreasing the rate of local recurrence as well as prolong patient survival. If the tumor located at the near the anal canal, concerning issues will be whether anal sphincter can be preserved or not and furthermore autonomic pelvic nervous system could be saved or not. Multidisciplinary approach for rectal cancer has been more popular and treatment strategy rapidly changing based on more accurate preoperative local staging finding and minimal invasive surgical techniques become popular too. One of the advance technology is the development of transanal local excision techniques such Transanal endoscopic microsurgery technique such as TEM(transendoscopic microsurgery), TEO(transendoscopic operation) and TAMIS (transanal minimal invasive surgery). Those techniques make us be able to excise early rectal cancer with full thickness as well as unfragmented state, also can be approached to the upper rectum, which can not approach with previous conventional transanal approach method. Local excision for early T1 rectal cancer has been regards as good treatment option because patient can avoid complication related to the radial proctotectomy such as anastomoitc leakage, postoperative sexual and voiding dysfunction and dysregulated bowel movements. Neoadjuvant chemoradiation therapy has been recommended for patient with cT3N0 or cT3 N+ rectal cancer because some clinical trials showed us preoperative chemoradiation therapy showed better local control rate and less toxicities than postoperative chemoradiation treatment. Recent clinical trial both retrospective and prospective showed us a promising results about local excision after neoadjuvant chemoradiation selectively in patients with low rectal cancer. Neoadjuvant chemoradiation therapy for cT2N0 followed by local excision reported excellent oncologic outcomes quite comparable to the radical surgery group. In addition to that, there has been some reports which showed clinical complete remission after neoadjuvant chemoradiation therapy could be wait and see. A couple of observational studies showed wait and see can be possible option of treatment in selective patients. Radial surgery for middle and low rectal cancer still remains a cornerstone of surgical treatment Ultralow anterior resection with or without intersphincteric resection became a more standard surgical method for low rectal cancer. Oncologic and functional outcomes has been reported as safe even functional outcomes study was rare. Furthermore, Abdominoperineal resection has been famous for high intraoperative tumor perforation and positive circumferential resection margin, those factors have been contributed to the high rate of local recurrence and poor survival rate compared with sphincter saving procedures for rectal cancer. Recently, there have been great efforts for reducing theses problem and total levator excision or extended abdominoperineal resection concepts emerged. Surgeons who advocated this concept recommended perineal dissection under the Jack-knife position. Surgical management for low rectal cancer should be directed for radically and preserving function based on multimodality approach. We need more high level of evidence based on prospective clinical trials for tailored treatment of rectal cancer patients