Microcirugía transanal endoscópica en el tratamiento para el cáncer del recto / Transanal Endoscopic Microsurgery for Treating Rectal Cancer

Introducción: La microcirugía transanal endoscópica es un procedimiento mínimamente invasivo que se aplica para el tratamiento local del cáncer del recto en estadios iniciales. Su utilización en estadios más avanzados del cáncer del recto resulta controversial. Sin embargo, con el uso rutinario del tratamiento neoadyuvante constituye una opción atractiva que se ha comenzado a considerar. Objetivo: Evaluar los resultados de la microcirugía transanal endoscópica para el tratamiento del cáncer del recto en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó un estudio retrospectivo de una base de datos prospectiva de 18 años. La muestra fue de 150 pacientes que cumplieron con los criterios de selección y las variables estudiadas fueron: edad, sexo, indicación, tiempo quirúrgico, entre otras. Resultados: La principal indicación fue el adenocarcinoma del recto T1. La edad media fue 63 años (32-93); el tiempo quirúrgico, 76 minutos (25-240) y el tamaño tumoral, 2,8 cm (1-4). La estancia hospitalaria fue de 1 día (12 horas-7 días), la morbilidad fue 6,7 porciento y las principales complicaciones posoperatorias fueron el sangramiento, la dehiscencia de sutura, el absceso, la fístula rectovaginal y la estenosis. La recurrencia local fue 8,2 porciento, 7,1 porciento y 2,5 porciento para los adenocarcinomas T1, T2 y T3 respectivamente. La supervivencia global a los 5 años fue 97,5 porciento y la supervivencia libre de enfermedad fue 95,5 porciento. Conclusión: La microcirugía transanal endoscópica es una técnica factible y segura en el tratamiento de los adenocarcinomas T1, mientras que en los T2 y T3 se requiere de la radioquimioterapia preoperatoria(AU)

Introduction: Transanal endoscopic microsurgery is a minimally invasive procedure applied for the local treatment of rectal cancer at early stages. Its use in more advanced stages of rectal cancer is controversial. However, with the routine use of neoadjuvant treatment, it is an attractive option that has begun to be considered. Objective: To assess the outcomes of transanal endoscopic microsurgery for the treatment of rectal cancer at Centro Nacional de Cirugía de Mínimo Acceso. Methods: A retrospective study of an 18-year prospective database was performed. The sample consisted of 150 patients who met the selection criteria and the variables studied were age, sex, indication, surgical time, among others. Results: The main indication was T1 rectal adenocarcinoma. The mean age was 63 years (32-93); surgical time, 76 minutes (25-240); and tumor size, 2.8 cm (1-4). Hospital stay was 1 day (12 hours-7 days), morbidity was 6.7 percent, and the main postoperative complications were bleeding, suture dehiscence, abscess, rectovaginal fistula and stenosis. Local recurrence was 8.2 percent, 7.1 percent and 2.5 percent for T1, T2 and T3 adenocarcinomas, respectively. Overall survival at 5 years was 97.5 percent and disease-free survival was 95.5 percent . Conclusion: Transanal endoscopic microsurgery is a feasible and safe technique for treating T1 adenocarcinomas, while T2 and T3 adenocarcinomas require preoperative radiochemotherapy(AU)

La escisión total del mesorrecto transanal en el tratamiento del cáncer del recto como nueva técnica en Cuba / Total Excision of the Transanal Mesorectum as a New Technique for Treating Rectal Cancer in Cuba

Introducción: Las indicaciones de la Microcirugía Transanal Endoscópica han evolucionado desde la cirugía de tumoraciones rectales hasta otras enfermedades pélvicas. La asociación de esta y la escisión total del mesorrecto transanal ofrece una serie de ventajas. Objetivo: Determinar las indicaciones, describir la técnica quirúrgica y mostrar los resultados a largo plazo obtenidos en la realización de la escisión total del mesorrecto transanal en el tratamiento del cáncer del recto medio y bajo. Métodos: Se realizó un estudio observacional descriptivo y prospectivo de los pacientes con cáncer del recto medio y bajo sometidos a esta técnica quirúrgica en el período comprendido entre febrero de 2017 y febrero de 2022 en el Centro Nacional de Cirugía de Mínimo Acceso. Resultados: Se operaron 13 pacientes, 9 con cáncer del recto bajo y 4 con cáncer del recto medio y un promedio de edad de 56,2 años (rango 28-76). El promedio de tiempo quirúrgico fue de 183 minutos (rango 120-270) y las pérdidas hemáticas estimadas de 68 mililitros. La incidencia de morbilidad mayor fue de 15,4 por ciento y la media de estadía hospitalaria de 5,4 días. La media del período de seguimiento fue de 35 (rango 9-69) meses con una recidiva local de 7,7 por ciento y una supervivencia global a los 5 años de 100 por ciento. Conclusiones: La escisión total del mesorrecto transanal combinado con cirugía laparoscópica es una técnica factible y segura. La introducción de la variante técnica utilizando el instrumental de la Microcirugía Transanal Endoscópica es más ergonómica y disminuye los costos(AU)

Introduction: The indications for transanal endoscopic microsurgery have evolved from surgery of rectal tumors to other pelvic diseases. The association between this and total excision of the transanal mesorectum offers a series of advantages. Objective: To determine the indications, to describe the surgical technique and to show the long-term outcomes obtained in the performance of total excision of the transanal mesorectum for treating cancer of the middle and lower rectum. Methods: A descriptive and prospective observational study was carried out of patients with cancer of the middle and lower rectum who underwent this surgical technique in the period from February 2017 to February 2022 at Centro Nacional de Cirugía de Mínimo Acceso. Results: Thirteen patients were operated on, 9 with cancer of the lower rectum and 4 with cancer of the middle rectum, as well as an average age of 56.2 years (range 28-76). The average surgical time was 183 minutes (range 120-270) and estimated blood loss was 68 milliliters. The incidence of highest morbidity was 15.4 percent and mean hospital stay was 5.4 days. The median follow-up period was 35 (range 9-69) months, with a local recurrence of 7.7 percent and an overall 5-year survival of 100 percent . Conclusions: Total excision of the transanal mesorectum combined with laparoscopic surgery is a feasible and safe technique. The introduction of the variant technique using the instruments of endoscopic transanal microsurgery is more ergonomic and reduces costs(AU)

Microcirugía transanal endoscópica como tratamiento de los tumores benignos del recto / Endoscopic Transanal Microsurgery as a Treatment of Benign Rectal Tumors

Introducción: La microcirugía transanal endoscópica es un procedimiento mínimamente invasivo para el tratamiento local de los grandes adenomas y los cánceres en estadios iniciales del recto. Objetivo: Evaluar los resultados de la microcirugía transanal endoscópica en los pacientes con tumores benignos del recto en el Centro Nacional de Cirugía de Mínimo Acceso de La Habana. Método: Se realizó un estudio retrospectivo de una base de datos prospectiva de 15 años. Se les ejecutó a un total de 91 pacientes con tumores benignos del recto la microcirugía transanal endoscópica entre abril de 2004 y diciembre de 2019. Se incluyeron las variables: edad, sexo, indicación, tiempo quirúrgico, localización del tumor, tamaño tumoral, estancia hospitalaria, complicaciones posoperatorias y recidiva local. Resultados: La principal indicación fue el adenoma del recto con 70 (76,9 por ciento) pacientes. La edad media fue de 63,4 años, el tiempo quirúrgico 81,1 minutos y el tamaño tumoral 3,5 cm. La estancia hospitalaria fue de 1 día y las complicaciones posoperatorias fueron 4 (4,3 por ciento): dos sangramientos, una dehiscencia de sutura y una estenosis. Dos pacientes (2,8 por ciento) tuvieron recidiva local en el grupo de los adenomas y no se realizaron conversiones a cirugía laparoscópica o cirugía abierta. Conclusión: La microcirugía transanal endoscópica fue una técnica factible y segura en el tratamiento de los adenomas del recto no resecables endoscópicamente, adenomas con displasia de alto grado y en otros tumores del recto(AU)

Introduction: Endoscopic transanal microsurgery is a minimally invasive procedure for local treatment of large adenomas and early-stage rectal cancers. Objective: To assess the outcomes of endoscopic transanal microsurgery in patients with benign rectal tumors at the National Center for Minimal Access Surgery in Havana. Methods: A retrospective study of a 15-year prospective database was carried out. A total of 91 patients with benign rectal tumors underwent endoscopic transanal microsurgery between April 2004 and December 2019. The following variables were included: age, sex, indication, surgical time, tumor location, tumor size, hospital stay, postoperative complications and local recurrence. Results: The main indication was rectal adenoma, accounting for 70 (76.9 percent) patients. The mean age was 63.4 years, surgical time was 81.1 minutes and tumor size was 3.5 cm. Hospital stay was one day. Postoperative complications were four (4.3 percent): two bleedings, one suture dehiscence and one stenosis. Two patients (2.8 percent) had local recurrence in the adenoma group. No conversions to laparoscopic or open surgery were performed. Conclusion: Endoscopic transanal microsurgery was a feasible and safe technique in the treatment of endoscopically unresectable rectal adenomas, adenomas with high-grade dysplasia and other rectal tumors.

Continence changes following transanal endoscopic microsurgery result from the impact on rectal capacity: clinical and functional evaluation before and after surgical treatment / Alterações da continência após microcirurgia endoscópica transanal resultam do impacto sobre a capacidade retal: avaliação clínica e funcional antes e após tratamento cirúrgico

ABSTRACT Introduction: Described in 1983 and with a stable clinical application, the impact of Transanal Endoscopic Microsurgery on anorectal function remains unknown. The objectives of the present study were to evaluate the impact of Transanal Endoscopic Microsurgery on anorectal function according to clinical (Wexner score) and functional (anorectal manometry) evaluations before and after surgery. Method: Prospectively, 23 consecutive patients with rectal lesions were operated using TEO® equipment (Karl Storz, Tuttlingen, Germany). For all patients, the value of Wexner score was obtained before and after surgery (7, 30 and 90 days) and anorectal electromanometry was performed before surgery, and also postoperatively (30 and 90 days). Results: Fourteen patients were men. The mean age was 53.7 (24-81) years. The mean distance from the lesion to the pectineal line was 7 (2-15) cm. The histopathologic analysis revealed adenoma in 14 (61%); neuroendocrine tumor in 5 (21.7%); invasive carcinoma in 3 (13%); and hyperplastic polyp in 1 (4.3%) case. The mean duration of postoperative follow-up was 5 (3-7) months. Wexner score was significantly lower at 30 days compared to 7 days (Wilcoxon; p = 0.03). Rectal capacity was significantly lower 30 days after surgery and recovered at 90 days of surgery (ANOVA; p = 0.04). Conclusions: After Transanal Endoscopic Microsurgery, a modest impact on anorectal function can be observed. The transient impairment results from loss of rectal capacity and not from impairment of the anal sphincters, being completely resolved 90 days after surgery.

RESUMO Introdução: Descrita em 1983 e de sólida aplicação clínica, o impacto da Microcirurgia Endoscópica Transanal sobre a função anorretal permanece pouco conhecido. Os objetivos do presente estudo foram avaliar o impacto da Microcirurgia Endoscópica Transanal na função anorretal conforme avaliações clínica (Wexner score) e funcional (manometria anorretal) antes e após a cirurgia. Método: Prospectivamente, 23 pacientes consecutivos com lesões retais foram operados com o uso do equipamento TEO® (Karl Storz, Tuttlingen, Alemanha). Para todos os pacientes, o valor do escore de Wexner foi obtido antes e após a cirurgia (7, 30 e 90 dias) e a eletromanometria anorretal foi realizada antes da cirurgia e também no pós-operatório (30 e 90 dias). Resultados: Quatorze pacientes eram homens. A idade média foi 53,7 (24-81) anos. A distância média da lesão à linha pectínea foi de 7 (2-15) cm. A histopatológica revelou adenoma em 14 (61%), tumor neuroendócrino em 5 (21,7%); carcinoma invasivo em 3 (13%) e pólipo hiperplásico em 1 (4,3%) caso. A duração média do seguimento pós-operatório foi de 5 (3-7) meses. O escore de Wexner foi significativamente menor aos 30 dias em comparação com 7 dias (Wilcoxon; p = 0,03). A capacidade retal foi significativamente menor aos 30 dias após a cirurgia e recuperada aos 90 dias após a cirurgia (ANOVA; p = 0,04). Conclusões: Após Microcirurgia Endoscópica Transanal, um impacto modesto na função anorretal pode ser observado. O comprometimento transitório resulta de perda de capacidade retal e não por comprometimento dos esfíncteres anais cessando completamente 90 dias após a cirurgia.

Transanal endoscopic microsurgery for local excision of rectal gastrointestinal stromal tumors / 中华胃肠外科杂志

OBJECTIVE@#To investigate the efficacy of transanal endoscopic microsurgery (TEM) combined with imatinib for rectal gastrointestinal stromal tumors(GIST).@*METHODS@#Clinical data of 35 patients with rectal GIST undergoing TEM at Peking Union Medical College Hospital from February 2008 to May 2017 were analyzed retrospectively. Operation details, postoperative recovery condition, and follow-up information were reviewed. The differences in clinicopathological features and perioperative parameters were compared between patients who received neoadjuvant therapy (12 patients, imatinib mesylate, oral, 400 mg daily for 6 months before surgery) and those without neoadjuvant therapy (23 patients).@*RESULTS@#Of 35 patients, 18 were males and 17 were females with the mean age of (49.3±13.3) years. Mean tumor diameter was (1.8±1.1) cm and mean distance from lower tumor margin to anal verge was (4.0±1.8) cm. Mean operative time was (82.4±21.1) minutes and mean blood loss was (11.7±7.5) ml. No conversion to laparotomy occurred. Complete resection with negative margins was achieved in all cases. Complications were classified according to Clavien-Dindo system: 4 cases of grade I, 3 of grade II and 1 of grade IIIb. The tumor size in patients who received neoadjuvant therapy reduced from (3.1±1.2) cm to (2.6±1.2) cm, though it was still larger than the tumor size in patients without neoadjuvant therapy[(1.5±0.8) cm, P0.05]. Thirty patients (85.7%) were followed up for (50.3±36.6) months, and no local recurrence or metastasis was observed.@*CONCLUSIONS@#TEM is safe and effective in the treatment of rectal GIST. Preoperative neoadjuvant therapy is beneficial to TEM in treating larger tumors without increasing operating time. Satisfactory follow-up result is observed.

Abordaje microquirúrgico transanal. Experiencia inicial. Indicaciones y resultados / Transanal microsurgical approach. Initial experience. Indications and results

Introducción: El tratamiento quirúrgico de las afecciones del recto bajo se encuentra en permanente revisión intentando mantener una adecuada función de continencia y urogenital. Una opción reciente es el abordaje microquirúrgico transanal. El objetivo del trabajo es evaluar una serie de pacientes tratados mediante dicho abordaje, analizando indicaciones, resultados inmediatos y alejados. Material y método: Se seleccionaron 41 pacientes operados en el período comprendido entre febrero de 2009 y febrero de 2015. Resultados: En 41 pacientes, las afecciones tratadas fueron: pólipos, 22; cáncer de recto, 14; estenosis de anastomosis, 2; absceso retrorrectal, 1; endometriosis, 1; poliposis adenomatosa familiar, 1. Los pacientes con pólipos llegaron a consulta: por primera vez, 15; recidivados, 4; segunda recidiva, 2; tercera recidiva, 1. Los procedimientos realizados fueron: resección local, 29; microcirugía transanal transabdominal (TATA), 6; dilatación de estenosis, 4; biopsia transrectal, 3; drenaje de absceso retrorrectal, 1; control de hemorragia, 1; colocación de stent, 1. En cáncer de recto: resección local, 7; biopsia transrectal, 2; TATA, 4; colocación de stent, 1. El tiempo operatorio promedio fue 48,6 minutos, y la estadía hospitalaria promedio 2,21 días. De los 29 pacientes en quienes se realizó resección local, fueron controlados 25 durante un período de 6 a 72 meses. Se complicaron 11 pacientes, sin mortalidad ni recidivas locales. Conclusiones: Este abordaje permite tratar lesiones del recto y último segmento del colon sigmoides. Otorga mejor visión permitiendo una disección más exacta, mejorando resultados postoperatorios inmediatos y alejados en patología benigna y maligna, minimizando la posibilidad de recidivas. (AU)

Introduction: The surgical treatment of conditions located at the low rectum is in constant review, triying to maintain proper urogenital and continence function. One of the most recent options is the transanal microsurgical. The aim of this paper is to analyze a series of patients treated with this approach, its indications, immediate and long term results. Material and Methods: 41 patients were analyzed retrospectively in the period between February 2009 and February 2015. Results: In these patients, treated conditions were polyps: 22; rectal cancer: 14; anastomotic stricture: 2; retrorectal abscess: 1; endometriosis: 1; familial adenomatous polyposis: 1. Patients affected with polyps reached the first consultation in 15 opportunities; 4 on first recurrence; 2 with second recurrence; 1 with third recurrence. The procedures were 29 local resections; 6 transanal transabdominal resections (TATA); 4 dilations of stenosis; 3 transrectal biopsies; 1 retrorectal abscess drainage; 1 hemorrhage control; 1 stent placement. In rectal cancer were: 7 local resection; 2 transrectal biopsies; 4 TATA; 1 stent placement. Mean operative time was 48.6 minutes and mean hospital stay was 2.21 days. Of the 29 patients in whom local resection was performed, 25 were controlled for a period of 6 to 72 months. 11 patients were complicated; no deaths or local recurrences were registered. Conclusions: This approach allows to treat lesions located throughout the rectum and the last segment of sigmoid colon. A better insight is obtained allowing a more accurate dissection, thus improving the immediate and remote postoperative results and minimizes the possibility of recurrence, particularly when it comes to benign conditions. (AU)

Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.

Transanal Endoscopic Microsurgery

No abstract available.

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

PURPOSE: The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM). METHODS: Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences. RESULTS: The average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days. CONCLUSION: TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

Safety and feasibility of transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in the treatment of lower rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection for lower rectal cancer.</p><p><b>METHOD</b>Clinical data of seventeen patients with low rectal cancer undergoing the transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in our department from November 2014 to June 2015 were retrospectively analyzed. The main outcome measures included the operative time, intra-operative blood loss, the intra- and post-operative complication rate, the distal resection margin (DRM) length and the circumferential resection margin(CRM) status of the pathological specimen, as well as the number of lymph nodes retried.</p><p><b>RESULTS</b>The surgery was completed smoothly for all the patients in this studying group, with no conversion to open surgery. Among all the seventeen patients, seven had a body mass index (BMI) of over 25. The average operative time was (178.0 ± 32.3) min. The average intra-operative blood loss was (50.6 ± 43.98) ml. The complications included one case of intra-operative presacral venous hemorrhage(5.9%), and 3 cases of post-operative anastomotic leak (17.6%). The average distance from the distal resection margin to the lower edge of the tumor was (2.2 ± 1.6) cm. The distal, proximal, and circumferential resection margins were all negative in 17 patients. The average number of lymph nodes retrieved was 14.5 ± 6.9. The average postoperative hospital stay was (10.6 ± 6.7) d. Patients were followed up for an average period of (7.0 ± 2.6) months.</p><p><b>CONCLUSION</b>Transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in the treatment of lower rectal cancer is technically safe and feasible.</p>

Application of transanal endoscopic microsurgery in anorectal diseases / 中华胃肠外科杂志

Transanal endoscopic microsurgery(TEM) is a safe and effective procedure for the treatment of local tumors, especially for the rectal villous adenoma (pT0), polyps with severe dysplasia and in situ carcinoma(pTis). It can also be applied as salvage surgery for incidental carcinoma after colonoscopy as well as in cases of giant villous adenoma. With the introduction of screening colonoscopy, more early polyps will be detected. We should be able to customize our treatment accordingly. On one hand, we want to prevent overkill and on the other hand to avoid under-treatment. This article is aimed to review the development of TEM and discuss its various indications.

Patient selection and operation standard of transanal endoscopic microsurgery / 中华胃肠外科杂志

The development of transanal endoscopic microsurgery (TEM) during the last 30 years has led to the evolution of the treatment in rectal neoplasms. TEM has revolutionized the technique and outcomes of transanal surgery. To our knowledge, this technique is currently the only one-port system in endoscopic surgery by which a direct endoluminal approach to the target organ by using a natural opening of the body become available. TEM affords the advantage of a less invasive transanal approach with low recurrence rates secondary to a more precise dissection due to enhanced visualization of the surgical field. Currently, TEM represents the standard treatment modality for large rectal adenomas and a surgical option in selected early rectal cancers. Its potential role in the treatment of more invasive cancer in combination with neoadjuvant therapies, and other rectal localized tumors are currently under evaluation. The current trend of TEM is favorable in China. TEM has also been increasingly used in the treatment of rectal neoplasms, but there are many problems in the development of TEM, for example, preoperative assessment is inadequate, patient selection is not precise enough, the surgical procedure is not standardized, etc. These problems require the majority of surgical colleagues to work together to make the standards scientifically and objectively in accordance with the actual situation of our country, so as to promote the healthy development and popularity of TEM in China.

Accuracy of endoscopic ultrasound in the preoperative staging and the guidance of transanal endoscopic microsurgery for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the accuracy of endoscopic ultrasound (EUS) in preoperative staging of rectal cancer and to guide the treatment of transanal endoscopic microsurgery (TEM) in early rectal cancer.</p><p><b>METHODS</b>Clinical data of 80 patients with rectal cancer receiving EUS examination for preoperative staging in our department between June and December 2012 were retrospectively analyzed. Consistence comparison of EUS preoperative staging and pathological staging was performed to identify the accuracy of EUS preoperative staging. All the patients underwent operation within 1 week after EUS examination. According to preoperative staging, early rectal cancer(Tis or T1N0M0) patients with lesions less 20 cm to anus underwent TEM.</p><p><b>RESULTS</b>The overall accuracy of EUS for preoperative T stage was 68.8%(55/80), and for T1, T2, T3, T4 was 91.3%(73/80), 83.8%(68/80), 77.5%(62/80), 85.0%(67/80), which had a good consistence with postoperative pathological T staging(Kappa=0.562). The overall accuracy of EUS for preoperative N stage was 52.7%(39/74), and for N0, N1, N2 stage was 64.9%(48/74), 55.4%(41/74), 85.1%(63/74), which had a poor consistence with postoperative pathological N staging(Kappa=0.235). Six patients underwent TEM successfully, with mean operation time 99(65 to 123) min, without intraoperative and postoperative complication, and were discharged 2-3 days after operation. Enteroscope showed good recovery 1 month later. Pathology confirmed that all the lesions were early rectal cancer. During postoperative follow-up of 14.8 (11 to 19) months, there was no local recurrence and distant metastasis.</p><p><b>CONCLUSION</b>Preoperative EUS has a good accuracy with pathologic T stage, and can guide TEM in early rectal cancer.</p>

Transanal endoscopic microsurgery (TEM): initial experience

INTRODUCTION: Transanal endoscopic microsurgery is a technique created in the 1980's for resections of rectal tumors. This technique is a good option for the resections of rectal tumors, with low morbidity and mortality. OBJECTIVE: To report the initial experience of two different services in the Brazilian Northeast, Bahia and Pernambuco. METHODS: Retrospective and descriptive data collected from January 2010 to June 2012 regarding the postoperative outcomes of patients who underwent transanal endoscopic microsurgery for rectal tumor resection in these services. RESULTS: Our initial experience consisted of 52 patients, being 59.6% males; 71.2% were benign diseases, and the mean distance from the anal margin was 5.6 cm. Mean hospital stay was 1.2 days. Complications included bleeding, perforation and entry to the abdominal cavity in three cases, as well as suture dehiscence and neoplasm recurrence in an advanced adenocarcinoma. CONCLUSION: Transanal endoscopic microsurgery is an excellent technical option for the resection of rectum adenomas, which are not feasible for endoscopic resection. The procedure may be used for other indications, as the resection of anal fistulae, being an useful instrument in colorectal surgery. (AU)

INTRODUÇÃO: A microcirurgia endoscópica transanal é uma técnica minimamente invasiva criada nos anos de 1980 para ressecção local de tumores retais. Essa técnica tem se mostrado uma boa opção para as ressecções de tumores retais, com morbidade baixa e mortalidade praticamente nula. OBJETIVO: Relatar a experiência inicial de dois serviços localizados no Pernambuco e na Bahia, Nordeste do Brasil. MÉTODOS: Estudo retrospectivo e descritivo realizado de janeiro de 2010 a junho de 2012 dos resultados pós-operatórios de pacientes submetidos à microcirurgia endoscópica transanal nestes dois serviços. RESULTADOS: Cinquenta e dois pacientes consecutivos submetidos a tratamento cirúrgico por meio de TEM foram revisados, 59,6% dos quais eram do sexo masculino. Em 71,2% dos casos, o procedimento foi realizado para lesões benignas, e a distância média dos tumores da borda anal foi de 5,6 cm. A média do período de internação foi de 1,2 dias. Das complicações encontradas, podemos citar sangramento, perfuração e entrada na cavidade abdominal em três casos, bem como deiscência de sutura e recidiva tumoral em um adenocarcinoma avançado. CONCLUSÃO: A microcirurgia endoscópica transanal é uma excelente alternativa técnica para os casos de ressecção de adenomas de reto que não são possíveis por colonoscopia. O procedimento pode ser utilizado em outras indicações, como a ressecção de fístulas anais, mostrando-se um instrumental útil na cirurgia colorretal. (AU)

Experiencias y perspectivas futuras de la microcirugía transanal endoscópica en Cuba / Cuban experience and the future perspectives of transanal endoscopic microsurgery

INTRODUCCIÓN. El objetivo del presente estudio fue evaluar la indicación y los resultados de la microcirugía endoscópica transanal (TEM) para el tratamiento de los tumores benignos y malignos del recto, en el Centro Nacional de Cirugía de Mínimo Acceso (La Habana). MÉTODOS. Se realizó una amplia revisión bibliográfica acerca del manejo actual de los tumores benignos y malignos de recto mediante TEM y se evaluaron los resultados de dicha técnica en un período de 4 años en el Centro Nacional de Cirugía de Mínimo Acceso. RESULTADOS. En el período estudiado se operaron 33 pacientes mediante esta técnica. Las principales indicaciones de la TEM fueron los adenomas (72,8 por ciento). El tiempo quirúrgico promedio fue de 189,1 min; se usó transfusión intraoperatoria en 4 pacientes (12,1 por ciento) y la estancia hospitalaria fue de 2,5 días. Las principales complicaciones transoperatorias fueron el sangramiento y la perforación en la cavidad peritoneal. Las complicaciones posoperatorias fueron la fístula rectovaginal, el sangramiento y la dehiscencia. El seguimiento de los pacientes osciló entre 1 y 54 meses (media 28,3), y se encontraron 2 recidivas locales en el grupo de los adenomas. CONCLUSIONES. La TEM es un método seguro y eficaz para el tratamiento de los tumores benignos y malignos del recto (en estadios iniciales). Es la técnica de elección en grandes adenomas rectales y cánceres de recto con estadios pT1 localizados en toda la ampolla rectal. Tiene todas las ventajas de la cirugía de mínimo acceso; los resultados de recidiva son similares a los de la cirugía abdominal y no tiene complicaciones de disfunción urinaria o sexual y las de incontinencia fecal son mínimas(AU)

INTRODUCTION: The aim of present study was to assess the indication and the results of transanal endoscopic microsurgery (TEM) for treatment of rectal benign and malign tumors in National Center of Minimal Access Surgery in Havana city. METHODS: A comprehensive review of literature was made on present managing of rectal benign and malign tumors by TEM and results of such technique were assessed during 4 years in National Center of Minimal Access Surgery. RESULTS: During study period 33 patients were operated on by this technique. Main indications of TEM were the presence of adenomas (72,8 percent). Mean surgical time was of 189,1 minutes; in 4 patients ( 12,1 percent) transoperative transfusion was used, and hospital stay was of 2,5 days. Main transoperative complications were the rectovaginal fistula, bleeding and dehiscence. Follow-up of patients fluctuates between 1 and 54 months (mean 28,3) with 4 local relapses in adenoma group. CONCLUSIONS: TEM is a safe and effective method for treatment of rectal benign and malign tumors (in early stages). It is the choice technique for the big rectal adenomas and rectum cancer with pT1 stages located in all the ampulla of rectum. It has all advantages of the minimal access surgery; relapse results are similar to that of abdominal surgery without complications of urinary or sexual dysfunction and that of fecal incontinence are minimal(AU)