Issa Nida, Fenig Yaniv, Khatib Muhammad, Yasin Mustafa, Powsner Eldad, Khoury Wisam
1 Department of Surgery, Hasharon Hospital, Rabin Medical Center , Petach Tikva, Israel .
2 The Sackler School of Medicine, Tel-Aviv University , Tel Aviv, Israel .
J Laparoendosc Adv Surg Tech A. 2017 Jun;27(6):605-610. doi: 10.1089/lap.2016.0420. Epub 2016 Dec 19.
The incidence of malignant synchronous colorectal tumors (SCRT) is between 2% and 5%, and the association of synchronous adenomatous polyps in colon cancer has been reported to be 15%-50%. Surgical resection is the primary treatment option for SCRT not amendable to endoscopic resection. Lesions in adjacent segments are usually treated with more extensive resection; however, there is still some controversy on how to best treat synchronous lesions in separate segments, especially when the rectum is involved. In this study, we aimed to report the outcome of patients with SCRT treated by laparoscopic colectomy combined with Transanal Endoscopic Microsurgery.
Data pertaining patients undergoing combined colectomy and Transanal Endoscopic Microsurgery (TEM) between 2004 and 2014 were retrospectively collected.
141 TEM performed in the study period, 9 (6.5%) with combined laparoscopic colectomy were included. Mean age was 69.1 ± 10.6 years. There were 6 (66%) right, 2 (22%) left, and one (11%) sigmoid colectomy. All rectal lesions were benign adenomas, with mean tumor size 2.5 cm, and distance from the verge 9 ± 2.5 cm. Lesions were located in lateral rectal wall in 4, posterior in 4, and anterior in one case. Seven patients had the colectomy before TEM, and 2 had the TEM first. Mean operative time was 245 minutes (range 185-313) for the combined procedures. Median time of hospitalization was 6 days (range 4-11). Six patients (66%) had prolonged postoperative diarrhea. The final rectal pathology reports were adenoma with high-grade dysplasia (HGD) in 5 patients and adenoma with low-grade dysplasia in four cases. The colon pathology was T1 N0 in 3, T2 N0 in one, T3 N1 in one, adenoma with HGD in 2, and no residual tumor in 2 patients. Two patients underwent re-TEM for recurrent adenoma of rectum at 14 and 18 months postoperatively.
The combination of TEM with laparoscopic colectomy is feasible and should be kept in mind as an alternative procedure in case of SCRT. However, more strict selection criteria should be considered and the disadvantages should be discussed with the patient.
恶性同步性结直肠肿瘤（SCRT）的发病率在2%至5%之间，据报道结肠癌中同步腺瘤性息肉的关联率为15% - 50%。手术切除是无法进行内镜切除的SCRT的主要治疗选择。相邻节段的病变通常采用更广泛的切除治疗；然而，对于如何最佳治疗不同节段的同步性病变，尤其是涉及直肠时，仍存在一些争议。在本研究中，我们旨在报告接受腹腔镜结肠切除术联合经肛门内镜显微手术治疗的SCRT患者的结果。
回顾性收集2004年至2014年间接受结肠切除术联合经肛门内镜显微手术（TEM）的患者数据。
在研究期间共进行了141例TEM，其中9例（6.5%）联合了腹腔镜结肠切除术。平均年龄为69.1±10.6岁。右半结肠切除术6例（66%），左半结肠切除术2例（22%），乙状结肠切除术1例（11%）。所有直肠病变均为良性腺瘤，平均肿瘤大小为2.5 cm，距肛缘9±2.5 cm。病变位于直肠侧壁4例，后壁4例，前壁1例。7例患者在TEM之前进行了结肠切除术，2例先进行了TEM。联合手术的平均手术时间为245分钟（范围185 - 313分钟）。中位住院时间为6天（范围4 - 11天）。6例患者（66%）术后出现持续性腹泻。最终直肠病理报告显示5例为高级别异型增生（HGD）腺瘤，4例为低级别异型增生腺瘤。结肠病理结果为T1 N0 3例，T2 N0 1例，T3 N1 1例，HGD腺瘤2例，2例患者无残留肿瘤。2例患者在术后14个月和18个月因直肠腺瘤复发接受了再次TEM。
TEM与腹腔镜结肠切除术联合是可行的，在SCRT的情况下应作为一种替代手术方式予以考虑。然而，应考虑更严格的选择标准，并与患者讨论其缺点。
