Custo comparado da Microcirurgia Endoscópica Transanal (TEM) com a retossigmoidectomia anterior e com a cirurgia de amputação abdômino-perineal do reto

Moraes, Roberto da Silveira; Sobottka, Wagner Herbert; Zanchet, Marcos Vinícius; Lima, João Henrique Felício de; Morgenstern, Glauco Afonso; Schulz, Gustavo Justo; Bueß, G.; Malafaia, Osvaldo; Coelho, Júlio Cézar Uili

doi:10.1590/s0102-67202007000300006

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…Recently they have analyzed data related to cost effectiveness and cost benefit in a series of patients undergoing TEM. Such parameters compared to conventional techniques of rectal resection (anterior resection or abdominoperineal amputation) also showed significantly favorable tendency 24 . In another study, stimulating patients underwent TEM to relate positive and negative aspects of the procedure the main positive aspects were no postoperative scarring and no permanent colostomy.…”

Section: Morbiditymentioning

confidence: 87%

“…What we have not performed a total mesorectal excision in pT1 tumor and there was surprise appearance of liver metastasis after five years? A radical operation also does not provide 100% cure for pT1 tumors 24 . Bach et al 2 conducted a multicenter study, 20 centers in English and a Belgian, using a selection of well established, based on the risk spectrum, ie, tumors smaller than 4 cm, well differentiated, without invasion angioloinfatica and invading only the top third of the submucosa.Could conclude that the probability of risk of lymph node invasion is directly related to depth of invasion and that those low-risk lesions is approximately 3%, which authorizes the implementation of TEM alone.…”

Section: Morbiditymentioning

confidence: 99%

“…A rectovaginal fistula was observed in a re-resection of pT1 carcinoma due to excessive cauterization of the bloody bed. Conservative treatment was done, with subsequent closure of the fistula 24 . There were three post-operative bleeding which stopped spontaneously without reintervention, treated with fluid replacement.…”

Section: Morbiditymentioning

confidence: 99%

“…Began to be practiced since 1982 in Germany and, currently, is used in major centers. Its introduction in Brazil was due to the first author of this paper in 2002 at the Department of Digestive Surgery, Hospital de Clínicas, Federal University of Paraná in Curitiba, Brazil 20,21,22,23,24,25 . This paper presents the results of a non-random prospective series of patients with early rectal cancer treated by transanal endoscopic microsurgery.…”

Section: Introductionmentioning

confidence: 99%

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Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Moraes¹,

Losso²,

Matias³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Background -The total mesorectal excision is considered the standard operation in the treatment of rectal tumors, although there is no scientific proof that it should be used for all stages of the disease. It has been demonstrated that in selected cases of rectal tumors, promising results can be achieved with local treatment by transanal endoscopic microsurgery. These tumors, called early rectal cancer, T1 tumors, are less than 4 cm, well differentiated without angiolymphatic invasion -pT1 SM1. As the risk of lymph node involvement in these tumors is approximately 3%, local resection would have a great chance to be curative. Aim -To present the results of a nonrandom prospective series of patients with early rectal cancer treated by transanal endoscopic microsurgery. Methods -Between 2002 and 2010, 38 patients evaluated by preoperative protocol as patients with early rectal cancer underwent endoscopic microsurgical resection of the entire rectal wall including the tumor when located between 2 and 8 cm from the dentate line. The preoperative evaluation consisted of digital rectal examination, rigid sigmoidoscopy macrobiopsies, barium enema and/or colonoscopy, endorectal ultrasound and abdominal computed tomography of the abdomen, chest radiography and serum CEA. Was conducted follow-up with endoscopy and endorectal ultrasound every three months during the first two years, and every six in the next three years, and CEA every six months during the same period of five years. Was evaluated the tumor recurrence, morbidity and mortality. Results -Pathologic evaluation considered 29 categorized as low risk and nine being high. The follow-up in the series ranged from one to seven years. Tumor recurrence was confirmed in two of the 38 cases (5.26%), in one the lesion was considered high and another low risk. Conclusion -Transanal endoscopic microsurgery associated or not to adjuvant therapy, may be, currently, considered the gold standard in local rectal resection, with encouraging results in cases chosen with early rectal tumors at low risk. ABCDDV/774RESUMO -Racional -A excisão total do mesorreto é considerada a operação padrão no tratamento dos tumores do reto, apesar de não existir comprovação científica de que ela deva ser usada para todos os estádios da doença. Tem sido demonstrado que em casos escolhidos de tumores retais, resultados promissores podem ser conseguidos com tratamento local por microcirurgia endoscópica transanal. Tais tumores, denominados de câncer retal precoce, são tumores T1 -menores do que 4 cm -, bem diferenciados sem invasão angiolinfática pT1 Sm1. Como o risco de comprometimento linfonodal nesses tumores é de aproximadamente 3%, a ressecção local teria grande chance de ser curativa. Objetivo -Apresentar os resultados de uma série prospectiva não randômica de pacientes portadores de câncer retal precoce submetidos ao tratamento local por microcirurgia endoscópica transanal. Métodos -Entre 2002 e 2010, 38 pacientes avaliados por protocolo pré-operatório como portadores câncer retal pre...

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Section: Morbiditymentioning

confidence: 87%

Section: Morbiditymentioning

confidence: 99%

Section: Morbiditymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Moraes¹,

Losso²,

Matias³

et al. 2011

ABCD, arq. bras. cir. dig.

Self Cite

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Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

Mendes

Valadão

Araujo

et al. 2015

ABCD, arq. bras. cir. dig.

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RationalIn the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge.AimTo describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer.MethodThe TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM).ResultThe TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision).ConclusionThis is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

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Health Economic Evaluations of Cancer in Brazil: A Systematic Review

Campolina

et al. 2018

Front. Public Health

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Background: A large number of health economic evaluation (HEE) studies have been published in developed countries. However, Brazilian HEE literature in oncology has not been studied. Objective: To investigate whether the scientific literature has provided a set of HEE in oncology capable of supporting decision making in the Brazilian context.Methods: A systematic review was conducted to identify and characterize studies in this field. We searched multiple databases selecting partial and full HEE studies in oncology (1998-2013).Results: Fifty-five articles were reviewed, of these, 33 (60%) were full health economic evaluations. Type of cancers most frequently studied were: breast (38.2%), cervical (14.6%), lung (10.9%) and colorectal (9.1%). Procedures (47.3%) were the technologies most frequently evaluated. In terms of the intended purposes of the technologies, most (63.6%) were treatments. The majority of the incremental cost-effectiveness ratios (ICERs) reported have been below the cost-effectiveness threshold suggested by the World Health Organization (WHO).Conclusions: There has been an increase in the number of HEEs related to cancer in Brazil. These studies may support decision-making processes regarding the coverage of and reimbursement of healthcare technologies for cancer treatment in Brazil.

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Custo comparado da Microcirurgia Endoscópica Transanal (TEM) com a retossigmoidectomia anterior e com a cirurgia de amputação abdômino-perineal do reto

Cited by 3 publications

References 15 publications

Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

Health Economic Evaluations of Cancer in Brazil: A Systematic Review

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