Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions. / Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. METHODS: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. RESULTS: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. CONCLUSIONS: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques.

Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas / Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions

Introducción: La microcirugía endoscópica transanal (TEM) se diseña como una alternativa menos agresiva en el tratamiento de lesiones rectales (principalmente adenomas y adenocarcinomas). Sin embargo, su uso se ha ampliado a otras lesiones rectales para intentar disminuir la morbilidad añadida a técnicas más invasivas. El objetivo de este estudio es mostrar nuestra experiencia en el uso de la TEM en el tratamiento de otras lesiones rectales, diferentes de adenomas y adenocarcinomas. Métodos: Estudio retrospectivo descriptivo en el que se incluyen pacientes intervenidos mediante TEM para el tratamiento de lesiones rectales (diferentes a adenomas o adenocarcinomas) desde junio de 2008 hasta diciembre de 2016. Resultados: Entre los 138 pacientes operados mediante TEM en nuestro servicio, 10 fueron tratados por lesiones diferentes a adenomas o adenocarcinomas. Las lesiones rectales fueron 3tumores neuroendocrinos primarios, una metástasis de tumor neuroendocrino, una estenosis rectal, un pólipo cloacogénico, un endometrioma, un tumor retrorrectal, un absceso presacro y una lesión sin filiar en tabique rectovaginal. El tiempo operatorio medio fue de 72 min y la estancia postoperatoria de 4,2 días. Solo un paciente necesitó reintervención por rectorragia. Conclusiones: La aplicación del TEM para el tratamiento de lesiones rectales diferentes a adenomas o adenocarcinomas puede ser una herramienta útil que potencialmente ayude a disminuir la morbilidad asociada a otros tipos de técnicas quirúrgicas más invasivas (AU)

Introduction: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. Methods: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. Results: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. Conclusions: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques (AU)

Coexistencia de síndrome de Peutz-Jeghers y síndrome de Lynch en un mismo paciente / Coexistence of Peutz-Jeghers’ syndrome and Lynch’s syndrome in the same patient

Resumen El síndrome de Peutz-Jeghers es un síndrome polipósico infrecuente, definido por la presencia de pólipos hamartomatosos en el tracto gastrointestinal y por la presencia de pigmentación mucocutánea (especialmente en región buconasal, perianal, manos y pies).Es un trastorno autosómico dominante causado por una mutación germinal en el STK11 (LKB1). El riesgo de cáncer de mama y gastrointestinal está aumentado en esta entidad. El síndrome de Lynch forma parte del síndrome de cáncer colorrectal hereditario no asociado a poliposis. Está causado por una mutación en los genes reparadores del ADN y aumenta el riesgo de cáncer de colon y endometrio, así como otros tipos de neoplasias (ovario, tracto urológico alto, gástricas, de intestino delgado, páncreas, piel y cerebro).Presentamos el caso de una mujer joven con cáncer colorrectal en la que se demostró la coexistencia de ambos síndromes, una asociación aún no descrita en la literatura hasta la fecha (AU)

Abstract Peutz-Jeghers’ syndrome is an uncommon polyposis syndrome characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation (especially in the oral-nasal and perianal areas and hands and feet). Inheritance is autosomal dominant, caused by a germline mutation in the STK11 (LKB1) gene. The risk of breast and gastrointestinal cancer is increased in this syndrome. Lynch’s syndrome is also known as hereditary non-polyposis colorectal cancer. This syndromeis caused by a mutation in DNA mismatch repair genes and increases the risk of colon and endometrial cancer, as well as that of other neoplasms (ovary, upper urological tract, gastric, small intestine, pancreas, skin and brain). We present the case of a young woman with colorectal cancer and the coexistence of both syndromes. This association has not previously been reported in the literature (AU)

[Coexistence of Peutz-Jeghers' syndrome and Lynch's syndrome in the same patient]. / Coexistencia de síndrome de Peutz-Jeghers y síndrome de Lynch en un mismo paciente.

Peutz-Jeghers' syndrome is an uncommon polyposis syndrome characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation (especially in the oral-nasal and perianal areas and hands and feet). Inheritance is autosomal dominant, caused by a germline mutation in the STK11 (LKB1) gene. The risk of breast and gastrointestinal cancer is increased in this syndrome. Lynch's syndrome is also known as hereditary non-polyposis colorectal cancer. This syndrome is caused by a mutation in DNA mismatch repair genes and increases the risk of colon and endometrial cancer, as well as that of other neoplasms (ovary, upper urological tract, gastric, small intestine, pancreas, skin and brain). We present the case of a young woman with colorectal cancer and the coexistence of both syndromes. This association has not previously been reported in the literature.