Guerrieri M, Baldarelli M, Organetti L, Grillo Ruggeri F, Mantello G, Bartolacci S, Lezoche E
Department of General Surgery, University Politecnica delle Marche, Azienda Ospedaliera Umberto I, Clinica di Chirurgia Generale e Metodologia Chirurgica, Ancona, Italy.
Surg Endosc. 2008 Sep;22(9):2030-5. doi: 10.1007/s00464-008-9976-y. Epub 2008 Jun 14.
Local therapy for early rectal cancer is a valid alternative to the classical radical operation, which has a higher morbidity and mortality rate. The use of high-dose preoperative radiation appears to enhance the options for sphincter-saving surgery even for T2-T3 rectal cancer patients with effective local control. The authors report their experience with transanal endoscopic microsurgery (TEM) used to manage selected cases of distal rectal cancer without evidence of nodal or distant metastasis (N0-M0).
The study enrolled 196 patients with rectal cancer (51 T1, 84 T2, and 61 T3). All the patients staged preoperatively as T2 and T3 underwent preoperative high-dose radiotherapy, and since 1997, patients younger than 70 years in good general condition also have undergone preoperative chemotherapy.
Minor complications were observed in 17 patients (8.6%) and major complications in only 3 patients (1.5%). The definitive histology was 33 pT0 (17%), 73 pT1 (37%), 66 pT2 (34%), and 24 pT3 (12%). Eight patients (5 pT2 and 3 pT3) experienced local recurrence (4.1%). The rectal cancer-specific survival rate at the end of the follow-up period was 100% for pT1, 90% for pT2, and 77% for pT3 patients.
Patients with T1 cancer and favorable histologic features may undergo local excision alone, whereas those with T2 and T3 rectal cancer require preoperative radiochemotherapy. The results in the authors' experience after TEM appear not to be substantially different in terms of local recurrence and survival rate from those described for conventional surgery.
早期直肠癌的局部治疗是经典根治性手术的一种有效替代方案，经典根治性手术的发病率和死亡率更高。即使对于T2 - T3期直肠癌患者，高剂量术前放疗似乎也能增加保留括约肌手术的选择，并实现有效的局部控制。作者报告了他们使用经肛门内镜显微手术（TEM）治疗部分远端直肠癌且无淋巴结或远处转移证据（N0 - M0）病例的经验。
该研究纳入了196例直肠癌患者（51例T1期，84例T2期，61例T3期）。所有术前分期为T2和T3期的患者均接受了术前高剂量放疗，自1997年起，70岁以下且全身状况良好的患者还接受了术前化疗。
17例患者（8.6%）出现轻微并发症，仅3例患者（1.5%）出现严重并发症。最终组织学检查结果为33例pT0（17%），73例pT1（37%），66例pT2（34%），24例pT3（12%）。8例患者（5例pT2和3例pT3）出现局部复发（4.1%）。随访期末，pT1期患者的直肠癌特异性生存率为100%，pT2期为90%，pT3期为77%。
具有良好组织学特征的T1期癌症患者可单独进行局部切除，而T2和T3期直肠癌患者则需要术前放化疗。根据作者的经验，TEM术后的局部复发率和生存率与传统手术相比似乎没有显著差异。
