Resección de tumoración rectal mediante cirugía transanal mínimamente invasiva (TAMIS) / Rectal tumor resected by transanal minimally invasive surgery (TAMIS)

La microcirugía endoscópica transanal (TEM, por sus siglas en inglés) es una técnica que se ha desarrollado desde los años 80 y tiene múltiples indicaciones. La cirugía transanal mínimamente invasiva (TAMIS, por sus siglas en inglés) se ha introducido como un enfoque alternativo al TEM, con las mismas indicaciones y algunas ventajas. Se reporta aquí el primer caso en Costa Rica de TAMIS, practicada exitosamente en un paciente de 85 años con una tumoración rectal de 4 cm de diámetro.

Transanal Endoscopic Microsurgery (TEM, for its acronym in English) is a technique developed in the 80s, which has many uses. Transanal Minimally Invasive Surgery (TAMIS, for its acronym in English) has been introduced as an alternative approach to TEM, with the same indications and some advantages. The case of an 85-yearold male with a 4 cm in diameter rectal tumor successfully resected by TAMIS is herein reported, which is the first case treated in this manner in Costa Rica.

Therapeutic Results of Transanal Endoscopic Microsurgery and Radical Surgery for T1, T2 Rectal Cancer

PURPOSE: Transanal endoscopic microsurgery (TEM) has gained increasing acceptance as a treatment of choice for early rectal cancer. The purpose of this study was to compare the results of TEM and radical surgery in patients with T1 and T2 rectal cancer. METHODS: From October 1994 to December 2000, 74 patients with T1 and T2 rectal adenocarcinoma treated with TEM were compared with 100 patients with T1N0M0 and T2N0M0 rectal adenocarcinoma treated with radical surgery. Retrospective analysis was made regarding to recurrence and survival rate. Neither group received adjuvant chemo-radiation. There was no significant difference in age, gender, tumor location and follow-up period between two groups, except tumor size. RESULTS: Of 74 patients in TEM group, 52 patients were T1 (70.3%) and 22 patients were T2 (29.7%). Of 100 patients in radical surgery group, 17 patients were T1 (17.0%) and 83 patients were T2 (83.0%). Five-year local recurrence rates were 4.1% for T1, 19.5% for T2 after TEM, 0% for T1 and 9.4% for T2 after radical surgery. There was no statistical difference between T1 rectal cancer (P=0.95), but in T2 rectal cancer, it was higher after TEM than after radical surgery (P=0.04). Five-year disease free survival rates showed no statistical difference between two groups (TEM group: 95.9% for T1, 80.5% for T2, radical surgery group: 94.1% for T1, 83.3%for T2; P=0.35, P=0.12). Five-year survival rate were 100% for T1, 94.7% for T2 after TEM and 92.9% for T1, 96.1% for T2 after radical surgery. There were no significant statistical difference between two groups (P=0.07, P=0.48). CONCLUSIONS: In T1 rectal cancer, there were no difference in recurrence and five-year survival rate between TEM and radical surgery group. In T2 rectal cancer, five-year survival rate showed no statistical difference between two groups, but TEM carried higher risk of local recurrence. Therefore careful selection of the patients is required for TEM and when proper muscle invasion is proven after TEM, further treatment should be considered.