Department of Colorectal Surgery, University Hospital, Zaragoza, Spain.
Int J Colorectal Dis. 2011 Apr;26(4):437-43. doi: 10.1007/s00384-011-1132-9. Epub 2011 Jan 27.
Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention.
In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment.
After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%.
Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.
由于缺乏前瞻性研究，直肠恶性肿瘤的局部切除仍然存在争议。本文的主要目的是分析经肛门内镜微创手术治疗具有治愈意图的直肠肿瘤患者的生存和复发情况。
1997 年，我们开始对 T1/T2 直肠肿瘤患者进行前瞻性方案：T1 低危（A 组）的患者行经肛门局部全层切除可视为治愈；T1 高危和 T2 低危肿瘤患者接受术后放疗（B 组）。1997 年至 2006 年期间，共纳入 88 例患者。68 例患者在术前检查后入组，20 例患者最初诊断为腺瘤，但术后明确的病理评估为腺癌。
根据最终的组织学发现，54 例患者归入 A 组，28 例归入 B 组，6 例患者立即接受根治性手术。1 例患者失访。在平均随访 71 个月后，81 例患者中有 7 例（4 例来自 A 组，3 例来自 B 组）复发。5 年总生存率为 94%，癌症特异性生存率为 96%。
我们的数据支持经肛门内镜微创手术是 T1 低危肿瘤的一种充分治疗方法，不需要额外的治疗措施。对于 T2 低危病变，我们的研究显示局部复发率高于根治性手术后的报道，但生存结局相似。
