Malignant Rectal Tumors Research Articles

Transanal Endoscopic Operations for Rectal Tumours

BackgroundTransanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. MethodsIn this article we present a series of 70 patients operated on with this procedure (TEO) in our centre. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery, …). ResultsThe indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5.7%). 3 patients (4%) needed emergency surgery.All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26.4 months (range 1–71 months), the overall recurrence for benign tumours was 9%, 8% for malignant pT1 and 12.5% for malignant pT2. Early salvage surgery was performed on 8 patients. ConclusionsTEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumours in early stages (pT1) with pathological confirmation.

Hybrid transanal endoscopic microsurgery: a novel approach to rectal neoplasm excision

Rectal neoplasm excision is a challenging issue in gastrointestinal endoscopy and surgery. This technical note describes a hybrid method for the excision of challenging rectal neoplasms. The procedure consists of the combined use of classic endoscopy and transanal endoscopic microsurgical instrumentation for full-thickness removal of a recurrent rectal polyp in a patient who had previously undergone endoscopic excision of a Tis rectal adenocarcinoma, located behind the valve of Houston and 9cm from the anal verge. The lesion was removed completely in 50min with no operative complication. The patient's postoperative course was uneventful, and she was discharged after 5days. Pathological examination of the specimen confirmed complete resection of the lesion with adequate disease-free margins. Hybrid transanal endoscopic microsurgery successfully combines the precision and flexibility of classic endoscopy with the radicality and safety of transanal endoscopic microsurgery for the treatment of demanding benign or early-stage malignant rectal tumours.

Cirugía endoscópica transanal en tumores rectales

BackgroundTransanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. MethodsIn this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery,…). ResultsThe indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery.All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. ConclusionsTEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation.

Accessing the challenging pre-sacral abscess

Dear Editor: Drainage of pre-sacral collections transrectally or percutaneously can be challenging due to difficulty of access. Transanal endoscopic surgery is a well-established technique used to resect benign or early malignant rectal tumours, either using a binocular stereoscopic operating rectoscope or a monocular laparoscopic equivalent, and a number of additional indications have been described for their use, including pelvic anastomotic stricturoplasty, excision of extraluminal pre-sacral tumours as well as drainage of pre-sacral abscesses which may otherwise be inaccessible. Transanal endoscopic microsurgery uses the stereoscopic equipment (Richard Wolf Medical Instruments Corporation), while the alternative produced by Storz is less expensive and fully compatible with standard laparoscopic equipment, and is referred to as transanal endoscopic operation (TEO). Patients can expect minimal effect on anorectal function despite the use of a large diameter rectoscope. TEO equipment was used to successfully drain an inaccessible pre-sacral abscess in a 53-year-old man with a bodymass index of 28. He had undergone reversal of a Hartmann's procedure which had been performed 7 months earlier for complicated diverticular disease with a pelvic abscess, and a tight anastomotic stricture at 10 cm from the anal verge was subsequently diagnosed another 7 months later after he complained of pelvic discomfort and obstructive symptoms. Imaging ruled out recurrent pelvic sepsis and he underwent three anastomotic balloon dilatations over a 12-month period, resulting in a widely patent anastomosis and a significant improvement in symptoms. Two years after the last dilatation, he developed new symptoms of coccygeal pain on prolonged sitting, which worsened over 5 months, and he subsequently developed additional symptoms of night sweats. A magnetic resonance imaging (MRI) scan confirmed a 4-cm pre-sacral abscess postero-superior to the anastomosis which remained widely patent. Long-term antibiotics did not improve his symptoms and little change in size was evident on repeat imaging, and transanal drainage was attempted under general anaesthesia. This was unsuccessful due to access difficulties related to the distance of the abscess from the anal canal and the patient's body habitus. The procedure was abandoned when no pus was able to be aspirated and a submucosal haematoma obscured the operative view. Symptoms persisted over 18 months despite repeated courses of antibiotics, until drainage was successfully achieved using TEO equipment. With the patient in lithotomy position, the 4.0-cm diameter, 7.5-cm long operating rectoscope facilitated access, providing a magnified view of the extraperitoneal anastomosis which was incised posteriorly using an ultrasonic dissector, deroofing a pre-sacral cavity which contained pus and was lined with granulation tissue. He was discharged on oral antibiotics 1 day after surgery and was reviewed in an outpatient setting 1month later. He described post-operative symptoms of faecal urgency and increased frequency, associated with ongoing night sweats and discharge of pus per rectum with minor bleeding, but all of these symptoms had fully resolved on further review 4 months later. The coccygeal pain also resolved post-operatively, and no incontinence was experienced. An MRI scan performed 5 months after surgery confirmed resolution of the chronic collection which measured 39 mm on imaging prior to the procedure. This case illustrates chronic sepsis with a delayed presentation after anastomotic balloon dilatation and highlights the ease of access achievable using laparoscopic equipment via an operating rectoscope to manage pelvic pathology which would otherwise be inaccessible using alternative modalities.

Atypical presentation of skull metastasis from rectal adenocarcinoma as an initial symptom of recurrence.

Most malignant rectal tumors are histopathologically characterized as adenocarcinoma and generally metastasize to distant organs such as the lungs or the liver. Metastasis of rectal carcinomas to the skull is extremely rare. This study reports the initial diagnosis of rectal adenocarcinoma recurrence in a 65-year-old female with scalp metastasis. The patient's history indicated a colorectal adenocarcinoma that was resected five years earlier. A skull metastasis from a rectal adenocarcinoma has not yet been reported in the literature as an initial symptom for recurrence. This paper suggests that skull metastasis from any part of the body must be considered in the differential diagnosis of soft tissue tumors in the skull even in the absence of intestinal symptoms.

Transanal Single-Port Surgery for the Resection of Large Polyps

Introduction: Transanal endoscopic microsurgery (TEM) is widely used for the excision of both benign and malignant rectal tumours. It is relatively expensive and can be a challenging technique. A recent development in laparoscopic surgery is the single-port technique (single-incision laparoscopic surgery, SILS). The SILS port is a flexible multichannel port for transumbilical laparoscopic surgery. Even though not developed for transanal use the port could be ideal because of its shape and texture. Methods: 12 patients underwent transanal resection using an SILS port and normal laparoscopic instruments. Results: 10 out of 12 patients were treated successfully with the SILS port. Two polyps were resected using an open transanal technique because the distance between the SILS port and the polyp was too small. The average operative time was 55 min (range 40–80 min). All patients could be discharged on the first postoperative day. There were no major complications. Conclusion: Our current data show that transanal surgery using a single port is a relatively easy procedure with operative times comparable to TEM. More surgeons will therefore be able to perform transanal endoscopic surgery.

Indications and Results of Transanal Endoscopic Microsurgery in the Treatment of Rectal Tumours in a Consecutive Series of 52 Patients

IntroductionThe abdominal approach for the treatment of rectal tumours is associated with considerable morbidity. Transanal endoscopic microsurgery (TEM) is a technical alternative, and less invasive than radical surgery, and thus, with a lower associated morbidity. Also, with the correct selection of patients, TEM shows similar oncological results to radical surgery. The objective of this study is to review our results with TEM and discuss its indications in the treatment of rectal tumours. Patients and methodAn observational, retrospective study with prospective collection of data conducted from July 2008 to January 2011. TEM indications were: benign rectal tumours non-resectable using colonoscopy; early malignant rectal tumours (T1N0M0) with good prognostic factors: neoplastic tumours in more advanced stages in selected patients (high surgical risk, refused radical surgery or stoma and palliative care). ResultsA resection was performed using TEM on 52 patients (35 benign and 17 malignant tumours). The mean hospital stay was 4.9 days, with an associated morbidity of 15.3%. The R0 resection in adenomas and carcinomas was 97.1% and 88.8%, respectively. During a follow-up of 15 (3–31) months, one recurrence of an adenoma was observed which was re-operated on using TEM. ConclusionsTEM is a safe and effective procedure for the treatment of benign and selected early malignant rectal tumours, and is associated with a low morbidity. However, it is a therapeutic strategy based on a multidisciplinary team, basically with careful selection of patients, a validated technique and a strict follow-up protocol.

Indicaciones y resultados de la microcirugía endoscópica transanal en el tratamiento de los tumores rectales en una serie consecutiva de 52 pacientes

Introduction The abdominal approach for the treatment of rectal tumours is associated with considerable morbidity. Transanal endoscopic microsurgery (TEM) is a technical alternative, and less invasive than radical surgery, and thus, with a lower associated morbidity. Also, with the correct selection of patients, TEM shows similar oncological results to radical surgery. The objective of this study is to review our results with TEM and discuss its indications in the treatment of rectal tumours. Patients and method An observational, retrospective study with prospective collection of data conducted from June 2008 to January 2011. TEM indications were: benign rectal tumours non-resectable using colonoscopy; early malignant rectal tumours (T 1N 0M 0) with good prognostic factors: neoplastic tumours in more advanced stages in selected patients (high surgical risk, refused radical surgery or stoma and palliative care). Results A resection was performed using TEM on 52 patients (35 benign and 17 malignant tumours). The mean hospital stay was 4.9 days, with an associated morbidity of 15.3%. The R 0 resection in adenomas and carcinomas was 97.1% and 88.8% respectively. During a follow-up of 15 (3-31) months, one recurrence of an adenoma was observed which was re-operated on using TEM. Conclusions TEM is a safe and effective procedure for the treatment of benign and selected early malignant rectal tumours, and is associated with a low morbidity. However, it is a therapeutic strategy based on a multidisciplinary team, basically with careful selection of patients, a validated technique and a strict follow-up protocol.

Incidence, treatment and outcome of rectal stenosis following transanal endoscopic microsurgery

As an alternative to more radical abdominal surgery, transanal endoscopic microsurgery (TEM) offers a minimally invasive solution for the excision of certain rectal polyps and early-stage rectal tumours. The patient benefits of TEM as compared to radical abdominal surgery are clear; nevertheless, some drawback is possible. The aim of our study was to determine the risk factors, treatment and outcomes of rectal stenosis following TEM. We analysed a series of 354 consecutive patients who underwent TEM for benign or malignant rectal tumours between 1997 and 2009. We recorded the maximum histological diameter of the lesion, and whether the lesion was circumferential. Rectal stenosis was defined as a rectal narrowing not allowing passage of a 12 mm sigmoidoscope. Histological results with a measured specimen diameter were available in 304 of the 354 cases. There were 11 stenoses in total (3.6%), 7 stenoses due to 9 circumferential lesions (78%) and 4 due to lesions with a maximum diameter ≥ 5 cm (3.2%). Two patients presented as emergencies, and the other 9 patients reported symptoms of increased stool frequency at follow-up. Three of the stenoses were associated with recurrent disease. All stenoses were treated by a combination of endoscopic/radiological balloon dilatation or surgically with Hegar's dilators. A median of two procedures were required to treat stenoses until resolution of symptoms. Rectal stenosis following TEM excision is rare. It is predictable in patients with circumferential lesions but is rare in patients with non-circumferential lesions with a maximum diameter ≥ 5 cm. It is effectively treated with surgical or balloon dilatation. Most patients require repeated treatments.

Transanal Endoscopic Microsurgery for Residual Rectal Cancer After Neoadjuvant Chemoradiation Therapy Is Associated With Significant Immediate Pain and Hospital Readmission Rates

Transanal endoscopic microsurgery may represent appropriate diagnostic and therapeutic procedure in selected patients with distal rectal cancer following neoadjuvant chemoradiation. Even though this procedure has been associated with low rates of postoperative complications, patients undergoing neoadjuvant chemoradiation seem to be at increased risk for suture line dehiscence. In this setting, we compared the clinical outcomes of patients undergoing transanal endoscopic microsurgery with and without neoadjuvant chemoradiation. Thirty-six consecutive patients were treated by transanal endoscopic microsurgery at a single institution. Twenty-three patients underwent local excision after neoadjuvant chemoradiation therapy for rectal adenocarcinoma, and 13 patients underwent local excision without any neoadjuvant treatment for benign and malignant rectal tumors. Chemoradiation therapy included 50.4 to 54 Gy and 5-fluorouracil-based chemotherapy. All patients underwent transanal endoscopic microsurgery with primary closure of the rectal defect. Complications (immediate and late) and readmission rates were compared between groups. Overall, median hospital stay was 2 days. Immediate (30-d) complication rate was 44% for grade II/III complications. Patients undergoing neoadjuvant chemoradiation therapy were more likely to develop grade II/III immediate complications (56% vs 23%; P = .05). Overall, the 30-day readmission rate was 30%. Wound dehiscence was significantly more frequent among patients undergoing neoadjuvant chemoradiation therapy (70% vs 23%; P = .03). Patients undergoing neoadjuvant chemoradiation therapy were at significantly higher risk of requiring readmission (43% vs 7%; P = .02). Transanal local excision with the use of endoscopic microsurgical approach may result in significant postoperative morbidity, wound dehiscence, and readmission rates, in particular, because of rectal pain secondary to wound dehiscence. In this setting, the benefits of this minimally invasive approach either for diagnostic or therapeutic purposes become significantly restricted to highly selected patients that can potentially avoid a major operation but will still face a significantly morbid and painful procedure.

Initial Experience with Transanal Endoscopic Microsurgery: the Need for Understanding the Limitations

IntroductionTransanal endoscopic microsurgery is an alternative to transanal excision or radical surgery for benign and carefully selected malignant rectal tumors. Advantages over transanal excision include better visualization, access to more proximal lesions, higher likelihood of negative margins, and lower recurrence rates. Compared to radical resection, patients experience lower rates of morbidity and mortality but may have higher rates of local recurrence. MethodsA review of a prospectively maintained database of patients scheduled for transanal endoscopic microsurgery was performed. ResultsNinety-three patients underwent 96 procedures for 13 carcinoid tumors, 1 submucosal mass, 46 adenomas, 12 in situ adenocarcinomas, and 21 invasive adenocarcinomas. Of these cases, 81.2% was successfully completed. There were nine complications (11.5%). Final pathology demonstrated 33 in situ and invasive adenocarcinomas. The mean follow-up was 25.9 months. The four recurrences (12.1%) occurred in: one tubulovillous adenoma, two in situ carcinomas, and one T2 lesion. ConclusionsTransanal endoscopic microsurgery is appropriate for benign lesions such as carcinoid tumors and adenomas and can also be curative in carefully selected patients with early-stage invasive rectal cancer. In cases of invasive adenocarcinoma, it should be reserved for low-risk cancers in patients who accept the possible increased risk of recurrence.

Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results

Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention. In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment. After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%. Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.

The Ferguson Operating Anoscope as a Minimally Invasive Option for the Treatment of Rectal Tumors

Transanal excision of rectal tumors may be performed using the Ferguson Operating Anoscope (FOA). This retrospective case series evaluates the effectiveness of FOA for the excision of selected benign and malignant rectal tumors. The office records of 97 patients with rectal tumors who underwent FOA transanal excision by a single surgeon from 1999 through 2009 were reviewed. In the 97 patients evaluated, 99 FOA transanal excisions were performed for 39 adenocarcinomas, 55 benign tumors, and five carcinoid tumors. The tumors were 0.5 to 13.5 cm in diameter and located an average of 6.9 cm (range, 1 to 15 cm) from the anal verge. Ninety-one per cent of cases were performed as an outpatient. Postoperative complications occurred in 14 per cent with transient effects on continence in 2 per cent and a mean blood loss of 66 mL. The recurrence rate for favorable T1 rectal cancers was 4.3 per cent and for adenomas was 5.9 per cent. In early follow up of adenomas and favorable T1 carcinomas, FOA transanal excision has similar application, morbidity, and recurrence rates as reported for transanal endoscopic microsurgery for rectal tumors within 15 cm from the anal verge. FOA may be considered a useful option for the minimally invasive treatment of rectal tumors.

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Based on review of the literature and in the authors experience, this review present the method and indications for TEM.

Transanal Endoscopic Microsurgery Resection of Rectal Tumors: Outcomes and Recommendations

Transanal endoscopic microsurgery provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. The purpose of this study was to review our experience with transanal endoscopic microsurgery to clarify its role in the treatment of different types of rectal pathology. A prospective database documented all patients undergoing transanal endoscopic microsurgery from October 1996 through June 2008. We analyzed patient and operative factors, complications, and tumor recurrence. For recurrence analysis, we excluded patients with fewer than 6 months of follow-up, previous excisions, known metastases at initial presentation, and those who underwent immediate radical resection following transanal endoscopic microsurgery. Two hundred sixty-nine patients underwent transanal endoscopic microsurgery for benign (n = 158) and malignant (n = 111) tumors. Procedure-related complications (21%) included urinary retention (10.8%), fecal incontinence (4.1%), fever (3.8%), suture line dehiscence (1.5%), and bleeding (1.5%). Local recurrence rates for 121 benign and 83 malignant tumors were 5% for adenomas, 9.8% for T1 adenocarcinoma, 23.5% for T2 adenocarcinoma, 100% for T3 adenocarcinoma, and 0% for carcinoid tumors. All 6 (100%) recurrent adenomas were retreated with endoscopic techniques, and 8 of 17 (47%) recurrent adenocarcinomas underwent salvage procedures with curative intent. Transanal endoscopic microsurgery is a safe and effective method for excision of benign and malignant rectal tumors. Transanal endoscopic microsurgery can be offered for (1) curative resection of benign tumors, carcinoid tumors, and select T1 adenocarcinomas, (2) histopathologic staging in indeterminate cases, and (3) palliative resection in patients medically unfit or unwilling to undergo radical resection.

Transanal endoscopic microsurgery for rectal tumors: experience at Korea’s National Cancer Center

Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to transanal excision, enabling complete local excision of selected benign or malignant rectal tumors. This study aimed to determine the surgical and oncologic results for rectal tumors excised by TEM. From November 2001 to October 2007, 45 patients underwent TEM for excision of adenoma (13 patients), carcinoid tumor (6 patients), and carcinoma (26 patients). The patients included 27 men and 18 women with a median age of 52 years (range, 22-72 years). The median tumor distance from the anal verge was 7 cm (range, 3-15 cm), and the median tumor size was 17 mm (range, 2-60 mm). There was no procedure-related morbidity or mortality. However, one patient with rectal carcinoma died of lung cancer during the follow-up period. Of 13 patients with adenomas, 1 patient (7.7%, 1/13) experienced local recurrence 5 months after surgery. No recurrence occurred for six patients with carcinoid tumors. Histologic examination of the carcinomas showed pathologic tumor (pT) stage 0 (ypT0) in 2 patients, pT1 in 17 patients (including ypT1 in 1 patient), pT2 in 6 patients, and pT3 in 1 patient. Immediate salvage surgery was performed for five patients (19%, 5/26). During a median follow-up period of 37 months (range, 5-72 months), one patient (3.8%, 1/26) experienced local recurrence. The overall and disease-free 5-year survival rates for patients with carcinoma were 96.2% and 88.5%, respectively. The TEM procedure is a safe and appropriate surgical treatment option for benign rectal tumors. With strict patient selection, it is oncologically safe for early-stage rectal carcinomas.

Metabolomic Characterization of Human Rectal Adenocarcinoma with Intact Tissue Magnetic Resonance Spectroscopy

This study was designed to test whether metabolic characterization of intact, unaltered human rectal adenocarcinoma specimens is possible using the high-resolution magic angle spinning proton (1H) magnetic resonance spectroscopy technique. The study included 23 specimens from five patients referred for ultrasonographic staging of suspected rectal cancer. Multiple biopsies of macroscopically malignant rectal tumors and benign rectal mucosa were obtained from each patient for a total of 14 malignant and 9 benign samples. Unaltered tissue samples were spectroscopically analyzed. Metabolic profiles were established from the spectroscopy data and correlated with histopathologic findings. Metabolomic profiles represented by principle components of metabolites measured from spectra differentiated between malignant and benign samples and correlated with the volume percent of cancer (P = 0.0065 and P = 0.02, respectively) and benign epithelium (P = 0.0051 and P = 0.0255, respectively), and with volume percent of stroma, and inflammation. Magnetic resonance spectroscopy of rectal biopsies has the ability to metabolically characterize samples and differentiate between pathological features of interest. Future studies should determine its utility in in vivo applications for non-invasive pathologic evaluations of suspicious rectal lesions.

UTILIDAD DEL ULTRASONIDO TRANSRECTAL SIN BALÓN EN LA ESTADIFICACION PREOPERATORIA DEL CÁNCER RECTAL

Objective: To determine the usefulness of Endorectal Ultrasound (ERUS) without balloon in preo- perative staging of malignant rectal tumors. Method: From July 2003 to July 2007 a study was performed in 57 patients diagnosed with cancer of the rectum, who underwent preoperative staging by transrectal ultrasonography to be subsequently compared with an anatomopathologic analysis of the surgical sample. Results: US staging according to degrees of invasion (T-stage) was coincident in 87,7 per cent with the anatomopathologic staging. Sensitivity and specifi - city values were 0,80 and 0,92 per cent respectively for UT2, while 0,94 and 0,81 per cent, respectively, for UT3. According to regional lymph nodes spread (N-stage), it exhibited a coincidence of 78,9 per cent; sensitivity was 0,82 per cent and specificity was 0,74 per cent for UN0; while sensitivity and specificity rea - ched values of 0,74 and 0,82 per cent, respectively, for UN1. Conclusion: Endorectal US without balloon has proved to be useful in the preoperative staging of malignant rectal tumors.

Diagnosis and treatment of malignant rectal gastrointestinal stromal tumor

目的 探讨恶性直肠间质瘤的诊断及治疗方法.方法 回顾性分析26例恶性直肠间质瘤的临床和病理资料.结果 26例患者均行手术治疗,其中行Miles术13例,Dixon术10例,Park术3例.其3年、5年生存率分别为93%、54%.中位生存时间为52个月.CD117、CD34表达率分别为96%、85%.结论 CD117和CD34是确诊恶性直肠间质瘤最有价值的依据,根治性切除是恶性直肠间质瘤的治疗原则。

Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasms. It is considered a safe and effective treatment but recurrence rates of 1-13% are reported for benign lesions. The aim of this study was to assess risk factors for local recurrence of benign rectal lesions and to evaluate mortality and morbidity following TEM. Data were prospectively collected from all patients undergoing TEM for benign adenomas from January 1998 to March 2005. The procedure was performed by a single surgeon and patients were regularly followed up. One hundred and forty-six procedures were included, with a median patient age of 74 years (range 22-92 years). The mean lesion area was 16 cm(2) (range 0.3-150 cm(2)) and the median distance from the dentate line was 9 cm (range 0-17 cm). Immediate complications included bleeding (six) and acute urinary retention (six). There has been one (0.68%) procedure-related death. After a median follow up of 39 months (range 4-89 months) there have been seven recurrences (4.8%), recurring at a mean time of 23.3 months (range 5-48 months). Only microscopic involvement of the circumferential resection margin was found to be significantly associated with recurrence (P = 0.0059). Recurrence was not associated with age, size of lesion, previous treatment, severity of dysplasia or use of the harmonic scalpel. TEM is a safe and effective treatment for benign rectal adenomas. Circumferential resection margin involvement is associated with recurrence, which tends to occur late. Therefore extended follow up is recommended.