scholarly journals Adjuvant chemoradiotherapy versus radical surgery after transanal endoscopic microsurgery for intermediate pathological risk early rectal cancer: A single-center experience with long-term surveillance

Surgery ◽  
2021 ◽  
Author(s):  
Yunhao Li ◽  
Xiaoyuan Qiu ◽  
Weikun Shi ◽  
Guole Lin
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Radical Surgery ◽  
Adjuvant Chemoradiotherapy ◽  
Early Rectal Cancer ◽  
Single Center ◽  
Single Center Experience ◽  
Endoscopic Microsurgery

scholarly journals Transanal endoscopic microsurgery (TEM) for early rectal cancer: single center experience

2013 ◽  
Vol 12 (3) ◽  
pp. 156-160
Author(s):  
Narimantas Evaldas Samalavičius ◽  
Marijus Ambrazevičius ◽  
Alfredas Kilius ◽  
Kęstutis Petrulis
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Survival Rates ◽  
Abdominoperineal Excision ◽  
Adjuvant Chemoradiotherapy ◽  
Early Rectal Cancer ◽  
Single Center Experience ◽  
Endoscopic Microsurgery ◽  
Lost To Follow Up

Background / objectiveTo evaluate the initial experience with transanal endoscopic microsurgery (TEM) for early rectal cancer in a single center.Patients and methodsFrom February 2010 to October 2012 a total of 16 patients underwent TEM for early rectal cancer. 7 were women and 9 men, age range 52 to 88 years (median – 71 years). Postoperative surveillance protocol, which includes rigid proctoscopy, CEA and endorectal ultrasound every 3 months during first two years, was applied to all patients after TEM.ResultsFinal histology revealed 10 (62.5% ) lesions to be T1 and 6 (37.5%) T2 cancers. There were no postoperative complications. All 6 patients in pT2 group and those in pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 1 to 27 months (median – 14 months). There was one local recurrence (6.25%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free.ConclusionsIn our hands, TEM was an alternative to standard total mesorectal excision in patients with low risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.Key words: early rectal cancer, transanal endoscopic microsurgery, recurrence, survival.Transanalinė endoskopinė mikrochirurgija anktyvam tiesiosios žarnos vėžiui gydyti Ligoniai ir metodaiNuo 2010 m. vasario iki 2012 m. spalio 16 pacientų, sergančių ankstyvuoju tiesiosios žarnos vėžiu, buvo gydyti TEM būdu (7 vyrai ir 9 moterys, amžius – nuo 52 iki 88 metų; mediana – 71 metai). Visiems pacientams buvo atliekama pooperacinėstebėsena: proktoskopija, endorektalinė sonoskopija ir CEA tyrimas kas 3 mėn. pirmus dvejus metus.RezultataiHistologinio tyrimo metu rasta 10 (62,5 %) T1 navikų ir 6 (37,5 %) T2 navikai. Artimųjų pooperacinių komplikacijų nebuvo. Visiems šešiems pT2 grupės pacientams ir pT1 didelės rizikos pacientams buvo pasiūlyta adjuvantinė chemoradioterapijaar skubus radikalus operacinis gydymas. Pacientai buvo stebimi nuo 1 iki 27 mėn. (mediana –14 mėn.). Vienam pacientui (6,25 %), atsisakiusiam abdominoperinealinės rezekcijos del žemo didelės rizikos T1 naviko, po chemospindulinio gydymonavikas atsinaujino. Po 7 mėn. šiam pacientui buvo atlikta abdominoperinealinė rezekcija (rpT2N0M0). Vienas pacientas pasitikrinti neatvyko. Kiti pacientai yra gyvi, jiems nėra recidyvo.IšvadosTEM yra alternatyvus gydymo metodas tradicinei totalinei mezorektalinei ekscizijai (TME) pacientams, sergantiems mažos rizikos tiesiosios žarnos vėžiu. Tolesnė stebėsena reikalinga siekiant įvertinti recidyvų dažnį ir išgyvenamumą po TEM esantinvazyviam tiesiosios žarnos vėžiui.Reikšminiai žodžiai: ankstyvas tiesiosios žarnos vėžys, gydymas, transanalinė endoskopinė mikrochirurgija.

Transanal endoscopic microsurgery: results of the first 50 cases

2012 ◽  
Vol 19 (1) ◽  
pp. 45-49
Author(s):  
Narimantas Evaldas SAMALAVIČIUS ◽  
Alfredas KILIUS ◽  
Kęstutis PETRULIS ◽  
Simona LETAUTIENĖ ◽  
Rūta GRIGIENĖ ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Rectal Wall ◽  
Anal Verge ◽  
Abdominal Cavity ◽  
Safety Margin ◽  
Adjuvant Chemoradiotherapy ◽  
Rectal Stricture ◽  
Early Rectal Cancer ◽  
Endoscopic Microsurgery

The aim of the study was to share the experience and first results of implementation of transanal endoscopic microsurgery (TEM) technique for the removal of rectal adenomas, early rectal cancer or rectal stricture in the Center of Oncosurgery, Oncology Institute of Vilnius University. Materials and methods. From October 2009 to October 2011, a total of 50 patients underwent TEM for rectal adenomas, early rectal cancer or rectal stricture. The patients were 25 women and 25 men, 31 to 87 years of age (average 65 years). Rectal lesions were from 0.9 to 7.0 cm in diameter, 3–13 cm from the anal verge. Full thickness excision with 1 cm safety margin was achieved in all cases except two (mucosal excision), followed by closing of the rectal wall defect in one-layer running monocryl 3.0 suture using silver clips. In one case (TEM was performed for T2 rectal cancer), abdominal cavity was penetrated and two-layer closure was preferred. Results. In these series of 50 patients there was 1 (2%) complication (cystitis). No postoperative exitus occurred. The hospitalisation period ranged from 2 to 13 days (average 6 days). Final histology revealed 30 (60%) tubular or villous adenomas, 6 (12%) carcinomas in situ (pTis), 7 (14%) T1, 4 (8%) T2 cancers, and well-differentiated neuroendocrine tumors in 3 (6%) were diagnosed. One patient underwent open partial TME in pT1 group; the tumor was in the upper third of rectum and preoperatively evaluated as pTis disease. In two cases (pT1 group) lymphovascular invasion was present on final pathology, so they were offered a postoperative adjuvant chemoradiotherapy. Other 4 patients in T1 group are under surveillance. All 4 patients with T2 lesions were offered adjuvant chemoradiotherapy, one patient refused further treatment. Conclusions. TEM is an alternative for transanal excision of rectal adenomas and early rectal cancer. Further follow-up is necessary to evaluate the recurrence rate of cancer in invasive cancer patients group.

Adjuvant Chemoradiotherapy Versus Radical Surgery After Transanal Endoscopic Microsurgery for Intermediate Pathological Risk Early Rectal Cancer: a Single Center Experience With Long-term Surveillance

2021 ◽  
Author(s):  
Yunhao Li ◽  
Xiaoyuan Qiu ◽  
Weikun Shi ◽  
Guole Lin
Keyword(s):  
Rectal Cancer ◽  
Functional Outcome ◽  
Adjuvant Treatment ◽  
Transanal Endoscopic Microsurgery ◽  
Large Diameter ◽  
Bowel Function ◽  
Adjuvant Chemoradiotherapy ◽  
Intermediate Risk ◽  
Early Rectal Cancer ◽  
Endoscopic Microsurgery

Abstract BackgroundThe choice of subsequent treatment for intermediate risk rectal tumors after Transanal endoscopic microsurgery (TEM) between adjuvant chemoradiotherapy and total mesorectal excision (TME) is controversial. The present study aimed to compare survival and functional outcome between these two strategies. Methods This retrospective study included intermediate risk early rectal cancer patients after TEM in our center between 2010 and 2017. Patients were divided into adjuvant treatment and TME groups. Intermediate risk was defined as pT1 with lymphovascular invasion, poor differentiation or large diameter (3-5 cm) or pT2 with small diameter(less than 3cm). The study was based on follow-up data on survival and results from distributed validated scales for functional outcome. ResultsPostoperative overall survival (OS) and disease-free survival (DFS) were comparable between groups (p = 0.619 and p = 0.712 respectively). Pathological T stage was an independent risk factor for DFS (HR 3.09, 95% CI 1.66 - 4.18, p = 0.044). Anorectal symptoms, such as buttock pain, was significantly prevalent in the TME group (p = 0.030). TME group presented with poorer bowel function, including stool urgency (p < 0.001), bowel frequency (p = 0.016), severity of LARS (p = 0.039) and total LARS score (p = 0.040). Except for a lower score of vaginal lubrication in TME group than the adjuvant treatment group, sexual function was similar between the groups. ConclusionLike TME, adjuvant chemoradiotherapy is an alternative option for intermediate risk early rectal cancer after TEM and is associated with similar survival outcomes and better bowel function.

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