[Site of local surgery in adenocarcinoma of the rectum T2N0M0]. / Lugar de la cirugía local en el adenocarcinoma de recto T(2)N(0)M(0).

INTRODUCTION: The local exeresis adenocarcinoma of the rectum T(2)N(0)M(0) (ADC-T2), using transanal endoscopic microsurgery (TEM), has the benefit of achieving lower morbidity with a better quality of life. However, local occurrence of the local exeresis is greater than 20%, which is unacceptable these days. PATIENTS AND METHODS: Prospective, observational follow up study. The tumours committee agreed that those ADC-T2 patients could have the following treatments: total mesorectal excision (TME), simple TEM, TEM with postoperative chemo- and radiotherapy (Ct-Rt), preoperative Ct-Rt with subsequent TEM and radical surgical rescue (TME) within at least 4 weeks. RESULTS: Of the 146 patients operated on using TEM, 75 had adenocarcinomas, 59 adenomas, 6 scarring wounds, 5 carcinoids and 1 GIST. Of the adenocarcinomas 22 were ADC-T2. Follow up: median of 16 months (range, 3-32 months). The overall local recurrence was 18% (4/22). According to the treatment strategy the local occurrence was: TEM as the only procedure, 20% (2/10). Radical surgical rescue was performed on 3 patients after TEM, with no local or systemic recurrences. TEM with Qt-Rt after surgery was performed on 6 patients, with a local recurrence of 33% (2/6). Ct-Rt and subsequent TEM in 3 patients, with no local or systemic recurrences. CONCLUSIONS: Treatment of ADC-T2 using simple TEM is not effective. The combination of Ct-Rt after TEM, does not improve the results of TME. It is possible to rescue those patients without changing the overall survival. Preoperative Ct-Rt and TEM appears to be the approach that obtains a clinical and histological response, although a response is needed by clinical trials.

Lugar de la cirugía local en el adenocarcinoma de recto T2N0M0 / Site of local surgery in adenocarcinoma of the rectum T2N0M0

Introducción: la exéresis local del adenocarcinoma de recto T2N0M0 (ADC-T2), mediante microcirugía endoscópica transanal (TEM), se beneficia en conseguir una menor morbilidad con mejor calidad de vida. Sin embargo, la recidiva local de la exéresis local es superior al 20%, inaceptable en estos momentos. Pacientes y método: estudio observacional de seguimiento prospectivo. Los pacientes ADC-T2 son consensuados en el comité de tumores a las actuaciones terapéuticas: escisión total del mesorrecto (ETM), TEM simple, TEM con quimiorradioterapia (Qt-Rt) postoperatoria, Qt-Rt preoperatoria con posterior TEM y rescate a cirugía radical (ETM) en menos de 4 semanas. Resultados: se ha intervenido a 146 pacientes mediante TEM; 75 adenocarcinomas, 59 adenomas, 6 lesiones cicatriciales, 5 carcinoides y 1 GIST. De los adenocarcinomas, 22 fueron ADC-T2. Seguimiento: mediana, 16 (intervalo, 3-32) meses. La recidiva local total ha sido del 18% (4/22). Según la estrategia terapéutica la recidiva local fue: TEM como único procedimiento en el 20% (2/10). Se realizó en 3 pacientes rescate a cirugía radical tras TEM, sin recidiva local ni sistémica. TEM con Qt-Rt posterior a la cirugía se realizó en 6, con una recidiva local del 33% (2/6). Se practicó Qt-Rt y posteriormente TEM en 3 pacientes, sin recidiva local ni sistémica. Conclusiones: el tratamiento del ADC-T2 mediante TEM simple no es razonable. La asociación de Qt-Rt tras TEM, no consigue mejorar los resultados a la ETM. Es factible rescatar a los pacientes sin que altere la supervivencia total. La Qt-Rt preoperatoria y TEM parece ser la línea cuando se consiga una respuesta histológica y clínica, aunque es necesaria la respuesta por parte de ensayos clínicos (AU)

Introduction: The local exeresis adenocarcinoma of the rectum T2N0M0 (ADC-T2), using transanal endoscopic microsurgery (TEM), has the benefit of achieving lower morbidity with a better quality of life. However, local occurrence of the local exeresis is greater than 20%, which is unacceptable these days. Patients and methods: Prospective, observational follow up study. The tumours committee agreed that those ADC-T2 patients could have the following treatments: total mesorectal excision (TME), simple TEM, TEM with postoperative chemo- and radiotherapy (Ct-Rt), preoperative Ct-Rt with subsequent TEM and radical surgical rescue (TME) within at least 4 weeks. Results: Of the 146 patients operated on using TEM, 75 had adenocarcinomas, 59 adenomas, 6 scarring wounds, 5 carcinoids and 1 GIST. Of the adenocarcinomas 22 were ADC-T2. Follow up: median of 16 months (range, 3¿32 months). The overall local recurrence was 18% (4/22). According to the treatment strategy the local occurrence was: TEM as the only procedure, 20% (2/10). Radical surgical rescue was performed on 3 patients after TEM, with no local or systemic recurrences. TEM with Qt-Rt after surgery was performed on 6 patients, with a local recurrence of 33% (2/6). Ct-Rt and subsequent TEM in 3 patients, with no local or systemic recurrences. Conclusions: Treatment of ADC-T2 using simple TEM is not effective. The combination of Ct-Rt after TEM, does not improve the results of TME. It is possible to rescue those patients without changing the overall survival. Preoperative Ct-Rt and TEM appears to be the approach that obtains a clinical and histological response, although a response is needed by clinical trials (AU)