Abstract
IntroductionTransanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention.Patients and MethodsDuring the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months.ResultsThe pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies.DiscussionThe significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy.ConclusionIn selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.
Highlights
Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention
We have extended the use of TEM in palliative treatment of adenocarcinoma recurrence after surgery in the elderly, where the resolution of the symptoms, like bleeding and/or sub-occlusion, the maximization of survival benefit, minimization of disease recurrence, and preservation of preoperative bowel function are acceptable results in select cases, allowing you to avoid overly demolition surgery, especially in relation to age-related comorbidities
1 woman had been subjected to TEM as first procedure for a lesion evaluated as T1NxM0 and in 1 male patient, 78 years old, local excision was performed after cycles of neoadjuvant chemo/radio terapy for a T2NxM0 lesion
Summary
Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. The microscopic trans-anal surgery, born from an idea by g. Thanks to a continuous improvement of surgical instruments, it’s possible realization of complex transanal surgical procedure, like excisions of full thickness resection with anastomotic reconstructions. Due to the effectiveness achieved, it possible to treat complex cancer cases, in accordance with the improvement of adjuvant and neoadjuvant chemo/radiotherapy. For patients with stage I T1/T2 rectal cancer, local management of rectal cancer has been increasingly considered as an alternative to traditional transabdominal resection. Given the increasing interest in organ and sphincter
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