Division of Colon and Rectal Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA.
Colorectal Dis. 2012 May;14(5):562-6. doi: 10.1111/j.1463-1318.2011.02726.x.
Rectal carcinoids are often inadequately resected by snare excision during colonoscopy. Transanal endoscopic microsurgery is a minimally invasive procedure with low morbidity that offers full-thickness excision with a low rate of negative margins. It presents an excellent alternative to radical surgery for mid and proximally located lesions. We report the largest United States (US) experience in the use of transanal endoscopic microsurgery for rectal carcinoids.
Data of patients who had undergone transanal endoscopic microsurgery for rectal carcinoids were prospectively collected and retrospectively analyzed. Patient and tumour characteristics, operative and perioperative details, as well as oncological outcomes were reviewed.
Over a 12-year period, 24 patients underwent transanal endoscopic microsurgery for rectal carcinoids. Of these, six (25%) were primary surgical resections and 18 (75%) were performed after incomplete snare excisions during colonoscopy. Three (17%) patients who underwent full-thickness resection after snare excision had residual tumour on histopathological examination. Negative margins were obtained in all cases. No recurrences were noted.
Transanal endoscopic microsurgery is effective and safe for the surgical resection of rectal carcinoids<2 cm in diameter, with typical features and located more than 5 cm from the anal verge. Transanal endoscopic microsurgery can be used for primary resection or for resection after incomplete colonoscopic snare excision.
直肠类癌在结肠镜检查中常因圈套切除术而切除不彻底。经肛门内镜微创手术是一种微创、发病率低的手术，可进行全层切除，切缘阴性率低。对于中高位病变，它是根治性手术的极好替代方法。我们报告了美国（US）在经肛门内镜微创手术治疗直肠类癌方面的最大经验。
前瞻性收集并回顾性分析了接受经肛门内镜微创手术治疗直肠类癌的患者数据。回顾了患者和肿瘤特征、手术和围手术期细节以及肿瘤学结果。
在 12 年期间，24 名患者接受了经肛门内镜微创手术治疗直肠类癌。其中，6 例（25%）为原发性手术切除，18 例（75%）为结肠镜检查中不完全圈套切除后的手术切除。3 例（17%）在圈套切除后进行全层切除的患者组织病理学检查仍有肿瘤残留。所有病例均获得阴性切缘。无复发。
经肛门内镜微创手术是治疗直径<2cm、特征典型且距肛门缘>5cm 的直肠类癌的有效且安全的方法。经肛门内镜微创手术可用于原发性切除或结肠镜检查不完全圈套切除后的切除。
