Guerrieri M, Baldarelli M, Rimini M, Gesuita R, Lezoche G, Romiti C, Lezoche E
¹ Department of General Surgery Università Politecnica delle Marche Ospedali Riuniti, Ancona, Italy -
Minerva Chir. 2013 Jun;68(3):289-98.
We present our experience in the treatment of rectal adenomas and selected cases of distal rectal cancer without evidence of nodal or distant metastasis (N0-M0) managed by transanal endoscopic microsurgery (TEM). This study examines our experience evaluating surgical morbidity, mortality and oncological outcome.
Eight hundred ten patients with rectal lesions (462 adenomas, 115 T1, 130 T2 and 103 T3) were enrolled. All patients staged preoperatively as T2 and T3 underwent preoperative high dose radiotherapy and since 1997 patients with less than 70 year old and good general conditions also preoperative chemotherapy.
Minor complications were observed in 69 patients (8.5%) whereas major complications only in 5 patients (0.6%). Definitive histology confirmed adenomas in 431 cases (93%), while in 310 malignant lesions we had: 51 pT0 (14.7%), 127 pT1 (36.5%), 139 pT2 (39.9%) and 31 pT3 (8.9%). Sixteen (4.6%) patients (9 pT2 and 7 pT3) developed local recurrence whereas 6 (1.7%) patients distant metastasis. The survival rate at the end of follow-up was 100% for pT1 and 90% and 77% for pT2 and pT3 patients.
TEM is safe and effective for rectal adenomas not removable endoscopically. T1 cancer may undergo local excision alone, while T2 and T3 lesions require preoperative radiochemotherapy. The results reported seems to be not very different in terms of local recurrence and survival rate to those after conventional surgery.
我们介绍经肛门内镜显微手术（TEM）治疗直肠腺瘤及部分无淋巴结或远处转移证据（N0-M0）的低位直肠癌病例的经验。本研究探讨我们评估手术并发症、死亡率及肿瘤学结局的经验。
纳入810例直肠病变患者（462例腺瘤、115例T1期、130例T2期和103例T3期）。所有术前分期为T2和T3的患者均接受术前高剂量放疗，自1997年起，年龄小于70岁且一般状况良好的患者还接受术前化疗。
69例患者（8.5%）出现轻微并发症，而仅5例患者（0.6%）出现严重并发症。最终组织学检查确诊431例（93%）为腺瘤，而在310例恶性病变中，我们有：51例pT0（14.7%）、127例pT1（36.5%）、139例pT2（39.9%）和31例pT3（8.9%）。16例（4.6%）患者（9例pT2和7例pT3）出现局部复发，而6例（1.7%）患者出现远处转移。随访结束时，pT1患者的生存率为100%，pT2和pT3患者的生存率分别为90%和77%。
TEM对于内镜下无法切除的直肠腺瘤是安全有效的。T1期癌症可单独行局部切除，而T2和T3期病变需要术前放化疗。报告的结果在局部复发和生存率方面似乎与传统手术后的结果没有太大差异。
