Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Abstract

-Background -The total mesorectal excision is considered the standard operation in the treatment of rectal tumors, although there is no scientific proof that it should be used for all stages of the disease. It has been demonstrated that in selected cases of rectal tumors, promising results can be achieved with local treatment by transanal endoscopic microsurgery. These tumors, called early rectal cancer, T1 tumors, are less than 4 cm, well differentiated without angiolymphatic invasion -pT1 SM1. As the risk of lymph node involvement in these tumors is approximately 3%, local resection would have a great chance to be curative. Aim -To present the results of a nonrandom prospective series of patients with early rectal cancer treated by transanal endoscopic microsurgery. Methods -Between 2002 and 2010, 38 patients evaluated by preoperative protocol as patients with early rectal cancer underwent endoscopic microsurgical resection of the entire rectal wall including the tumor when located between 2 and 8 cm from the dentate line. The preoperative evaluation consisted of digital rectal examination, rigid sigmoidoscopy macrobiopsies, barium enema and/or colonoscopy, endorectal ultrasound and abdominal computed tomography of the abdomen, chest radiography and serum CEA. Was conducted follow-up with endoscopy and endorectal ultrasound every three months during the first two years, and every six in the next three years, and CEA every six months during the same period of five years. Was evaluated the tumor recurrence, morbidity and mortality. Results -Pathologic evaluation considered 29 categorized as low risk and nine being high. The follow-up in the series ranged from one to seven years. Tumor recurrence was confirmed in two of the 38 cases (5.26%), in one the lesion was considered high and another low risk. Conclusion -Transanal endoscopic microsurgery associated or not to adjuvant therapy, may be, currently, considered the gold standard in local rectal resection, with encouraging results in cases chosen with early rectal tumors at low risk. ABCDDV/774RESUMO -Racional -A excisão total do mesorreto é considerada a operação padrão no tratamento dos tumores do reto, apesar de não existir comprovação científica de que ela deva ser usada para todos os estádios da doença. Tem sido demonstrado que em casos escolhidos de tumores retais, resultados promissores podem ser conseguidos com tratamento local por microcirurgia endoscópica transanal. Tais tumores, denominados de câncer retal precoce, são tumores T1 -menores do que 4 cm -, bem diferenciados sem invasão angiolinfática pT1 Sm1. Como o risco de comprometimento linfonodal nesses tumores é de aproximadamente 3%, a ressecção local teria grande chance de ser curativa. Objetivo -Apresentar os resultados de uma série prospectiva não randômica de pacientes portadores de câncer retal precoce submetidos ao tratamento local por microcirurgia endoscópica transanal. Métodos -Entre 2002 e 2010, 38 pacientes avaliados por protocolo pré-operatório como portadores câncer retal pre...

Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

“…The transanal endoscopic microsurgery (TEM, English Transanal Endoscopic Microsurgery) was introduced in 1983 by G. Buess as minimally invasive technique for resection of adenomas and early rectal carcinomas 2 , 14 - 20 .…”

Instabilidade de microssatélite - MSI nos marcadores (BAT26, BAT25, D2s123, D5S346, D17S250) no câncer de reto

“…There is evidence that these tumors are different in several aspects: location (proximal colon), age (less advanced), histological appearance (higher incidence of mucinous tumors) and prognosis (better survival compared to microsatellite stable CCR) 26 . However, MSI tumors are associated with resistance to chemotherapy with 5-fluorouracil (5FU) and shorter survival of patients after treatment with the drug 5,6,15,20 . MSI CCR marker can also be inherited or acquired susceptibility to other cancers such as gastric cancer, uterus and ovary 21 .…”