TITULO: LOCAL EXCISION OF EARLY RECTAL CANCER (T1) WITH TEM

AUTOR y COAUTORES: Dr. Simon Daniel Duek, Dr. Wisam Khoury

Nº DE REFERENCIA 9051

TIPO PRESENTACION: Contribución a los Relatos

CATEGORIA: Tratamiento multimodal del cáncer de recto

RESUMEN DE LA PRESENTACION:

ANTECEDENTES: Background: Local excision for early rectal cancer is appealing for its low morbidity and good functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome.

OBJETIVO: Objective: To review the authors experience with local excision of early rectal cancers by TEM(Transanal endoscopic microsurgery) and to assess patients outcome

DISEÑO: A retrospective chart review of patients who underwent local excision of early rectal cancer by TEM during the years 1995-2011 in the colorectal unit.

MATERIAL Y METODO: Methods: A retrospective chart review of patients who underwent local excision of early rectal cancer by TEM during the years 1995-2011 in the colorectal unit. Factors analyzed included those related to the patient [age, gender], tumor [size, distance from the anal verge, differentiation], and additional treatment.

RESULTADOS: Results: There were 34 patients with T1 rectal cancer that underwent transanal endoscopic microsurgery. In 31 patients (91%) surgical margins were free of tumor, in one (3%) margins were involved by the tumor and in 2 patients (6%) margins could not be stated. Post-operative complications were recorded in 2 patients (6%). There was no post-operative mortality. The mean hospital stay was 37 hours. 30 patients (88) were followed up for a mean period of 55 months. Two patients (6%) had salvage low anterior resection, one due to suspected local recurrence and one due to lymphovascular invasion in final pathology evaluation. No tumor was found in the specimens. One patients (3%) had local recurrence, 7 months post surgery. He received chemoradiotherapy and then an APR was done. He died 13 months later due to metastatic disease. Six patients died of unrelated reasons.

CONCLUSIONES: Conclusions: Local excision of early rectal cancer is an acceptable and feasible alternative to formal resection. It has low complication rate, short postoperative stay and low recurrence rate.