• 作者：Xavier Serra Aracil^a ; ^{jserraa@tauli.cat} ; Jordi Bombardó ; Juncá ; ^a ; Laura Mora Ló ; pez^a ; Manuel Alcantara Moral^a ; Isidro Ayguavives Garnica^a ; Ana Darnell Marti^b ; Alex Casalots Casado^c ; Carles Pericay Pijaume^d ; Rafael Campo Ferná ; ndez de Los Rí ; os^e ; Salvador Navarro Soto^a
• 关键词：Adenocarcinoma de recto T2 ; Cirug&iacute ; a local cá ; ncer de recto ; Microcirug&iacute ; a endoscó ; pica transanal ; TEM ; Cirug&iacute ; a local de tumores rectales
• 刊名：Cirug铆a Espa帽ola
• 出版年：2009
• 期刊代码：pca87_0009739X
• 类别：med
• 出版时间：February 2009
• 卷：85
• 期：2
• 页码：103-109
• 文件大小：244 K

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鈥?2 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.