Paci Marcello, Scoglio Daniele, Ursi Pietro, Barchetti Luciana, Fabiani Bernardina, Ascoli Giada, Lezoche Giovanni
Endolaparoscopic Surgery and Advanced Technology Unit, Department of Surgery Paride Stefanini Policlinico Umberto I, Rome, Italy.
Ann Ital Chir. 2010 Jul-Aug;81(4):269-74; discussion 283.
After Heald's revolution in 1982, who introduced the total mesorectal excision, for improve the results in terms of recurrance and survival rate, there is a need to explore new therapeutic options in treatment of sub-peritoneal rectal cancer. In particular, local excision represent more often a valid technique for non advanced rectal cancer treatment in comparison with the more invasive procedure, especially in elderly and/or in poor health patients. The introduction of TEM by Buess (transanal endoscopy microsurgery), has extended the local treatment also to classes of patients who would normally have been candidates for TME. The author gives literature's details and his experience in the use of TEM for early rectal cancer sub-peritoneal. The aim of the study is to analyze short and long term results in terms of local recurrence and survival rate comparing TEM technique with the other transanal surgery in rectal cancer treatment. Preoperative Chemio-Radio therapy and rigorous Imaging Staging are the first steps to planning surgery. It's time, for local rectal cancer, has come to make the devolution a few decades ago has been accomplished in the treatment of breast cancer
1982年希尔德发起了一场革命，他引入了全直肠系膜切除术，为了在复发率和生存率方面改善治疗效果，有必要探索治疗腹膜下直肠癌的新治疗选择。特别是，与更具侵入性的手术相比，局部切除术对于非晚期直肠癌治疗而言往往是一种有效的技术，尤其是对于老年患者和/或健康状况不佳的患者。布斯引入的经肛门内镜显微手术（TEM），也将局部治疗扩展到了那些通常会成为全直肠系膜切除术候选者的患者群体。作者给出了文献细节以及他使用TEM治疗早期腹膜下直肠癌的经验。该研究的目的是在直肠癌治疗中，比较TEM技术与其他经肛门手术，分析局部复发率和生存率方面的短期和长期结果。术前放化疗和严格的影像学分期是规划手术的首要步骤。对于局部直肠癌来说，是时候像几十年前乳腺癌治疗那样实现治疗方式的转变了。
