Local excision for rectal cancer

Balani, Alessandro; Turoldo, Angelo; Braini, Andrea; Scaramucci, M; Roseano, M; Leggeri, A

doi:10.1002/1096-9098(200006)74:2<158::aid-jso15>3.0.co;2-e

Cited by 27 publications

(17 citation statements)

References 16 publications

(29 reference statements)

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“…It is a less invasive procedure that, according to its indication criteria, brings benefits in terms of rectal and canal anal functional preservation, morbid-mortality and costs. 1,2 Literature estimates reveal that 40 to 50 % of the primary rectal cancer will be presented without lymphonodal commitment (T1, T2, T3 -No) as soon as diagnosed 26,27 and that 15% of the patients considered cured show tumors limited to the rectal wall (T1 -T3 -No). 28 Every year, more than 7000 patients with rectal cancer are potentially cured by local excision as the only therapeutic method.…”

Section: Discussionmentioning

confidence: 99%

“…Also, there is no randomized prospective studies and there is a lot of variation concerning the adjuvant therapy indication. 1,2,14,16,17,19 Another relevant aspect for literature data comparison is the biological characterization of the tumor, i.e., interaction tumor-host, which might be inferred by the morphology, histology, size, localization and invasive stage. This is essential for the therapeutic results comparison in patients with similar disease stages.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with high surgical risk, the LE shows smaller morbidity and mortality, with also less anorectal, urinary and sexual function alterations. [1][2][3] The most commonly used techniques for LE include the colonoscopy with polypectomy loops, conventional transanal excision (CTE), transanal endoscopic microsurgery (TEM) and the posterior access surgery. [4][5][6] For local rectal cancer surgical treatment, the TEM has been used since 1983 with positive results, low recurrence rates and less post-operation complications compared to conventional procedures.…”

Section: Introductionmentioning

confidence: 99%

“…18 The results of local treatment of rectal cancer are of difficult interpretation because the literature brings retrospective analysis of heterogeneous groups of patients, with different surgical indications and adjuvant therapies, while it lacks prospective homogeneous studies. 1,19 In our environment, the endoscopic transanal or surgical procedures for rectal tumors up to 15 cm of the anorectal line depend on the surgeon and/or endoscopist experience, on the equipment available and on the type of lesion. We use the CTE performed with anal retractors and basic surgical instruments for treatment of rectal lesions on the distal 1/3.…”

Section: Introductionmentioning

confidence: 99%

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Transanal endoscopic operation: a new proposal

Rocha

Féres

2008

Acta Cir. Bras.

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Purpose: The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. Methods: The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, postoperation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. Results: The results were favorable and equivalent to those described in the literature. Conclusions: The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.Key words: Rectal Surgery. Endoscopy. RESUMOIntrodução: A operação cirúrgica por acesso transanal no tratamento do câncer retal é uma das várias técnicas utilizadas nessa terapêutica. Há várias técnicas de excisão local para os tumores retais: O método cirúrgico transanal convencional, acessos posteriores, colonoscopia terapêutica e operações transanais endoscópicas. O objetivo é apresentar um novo método de ressecção transanal endoscópica (Operação Transanal Endoscópica -OTE), realizada com um proctoscópio cirúrgico idealizado para o procedimento e divulgar os resultados obtidos em 32 pacientes submetidos a OTE e compará-los com as técnicas atualmente empregadas. Métodos: Foram analisadas as proporções médias da recorrência, das complicações pós-operatórias e das ressecções posteriores por meio da técnica de metanálise. Para a distância e o tamanho das lesões retais, os tempos de operação e de hospitalização, foram feitos gráficos de acordo com o autor e a técnica. Resultados: Os resultados foram favoráveis e equiparáveis aos trabalhos analisados. Conclusão: Concluiu-se que: O proctoscópio utilizado na OTE demonstrou ser eficaz e de baixo custo; 2 -A OTE mostrou-se factível; 3 -A análise dos resultados com a OTE foram satisfatórios e similares às outras técnicas de ressecções transanais endoscópicas que são de alto custo e pouco disponíveis em nosso meio.Descritores: Cirurgia Retal. Endoscopia. Rocha JJR et al 94

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transanal endoscopic operation: a new proposal

Rocha

Féres

2008

Acta Cir. Bras.

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“…The treatment of choice for large sessile adenomas of the rectum up to the peritoneal reflection is a limited resection, usually performed transanally [ [1,2,7,17]. In such a case, the lesion must be located in the lower or middle rectum because of the difficulties reaching and properly dissecting higher lesions.…”

Section: Discussionmentioning

confidence: 99%

Combining ultrasonic dissection and the Storz operation rectoscope

Lirici¹,

Paola²,

Ponzano³

et al. 2003

Surg Endosc

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Role of endorectal ultrasound in the conservative management of rectal cancers

Kim

Wong

2000

Seminars in Surgical Oncology

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Endorectal ultrasonography (ERUS) extends the ability of the clinician to define the clinical features assessed on routine physical examination, and remains the best modality for accurately staging depth of penetration and presumptive nodal status in rectal cancers. The success of conservative management of rectal cancers is predicated on proper patient selection. The preoperative selection of the ideal patient for local therapies can be difficult, and the decision-making process takes into account many critical factors. Careful assessment of the T and N stages is critical in determining the success of conservative therapies, and directing treatment algorithms. Local resections with curative intent are limited to patients with T1N0 rectal cancers, and select patients with T2N0 tumors with favorable pathological criteria. Conservative management may also be extended to patients identified with significant underlying comorbid conditions staged preoperatively with unfavorable T2/T3 lesions, often combined with adjuvant therapies in a palliative setting. In addition, ERUS may have a role in the selection of those patients with more advanced lesions to neoadjuvant chemoradiation, followed by radical resection. Though not clearly defined, ERUS is evolving in its role in the postoperative follow-up of patients treated conservatively for rectal cancers, and can lead to the early detection of local recurrences. The widespread use of ERUS remains limited due to high operator variability and errors in interpretation; however, the role of ERUS in the postoperative management of rectal cancers is evolving and requires further evaluation.

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Local excision for rectal cancer

Cited by 27 publications

References 16 publications

Transanal endoscopic operation: a new proposal

Transanal endoscopic operation: a new proposal

Combining ultrasonic dissection and the Storz operation rectoscope

Role of endorectal ultrasound in the conservative management of rectal cancers

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