Local methods of treatment of rectal cancer

Cook,; Mortensen, McC.

doi:10.1046/j.1463-1318.2000.00183.x

Cited by 14 publications

(5 citation statements)

References 121 publications

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“…Unfortunately, the conventional transanal excision is characterized by a high incidence of remnant disease or early recurrence [8,9]. For more than 25 years, transanal endoscopic microsurgery (TEM) had revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large rectal adenomas [10][11][12], then offering a possibly curative treatment for early rectal cancer [13,14], and, finally, generating discussion on the potential role in the treatment of more invasive cancer in combination with neoadjuvant treatments [15][16][17][18]. The aim of this study was to identify risk factors associated with local recurrence after TEM and consequently to improve selection criteria for TEM.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

et al. 2011

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BackgroundIndications and results of local excision of rectal lesions are currently under debate. Transanal endoscopic microsurgery (TEM), allowing a precise, full-thickness excision, could improve oncological results in early rectal tumors. Methods A prospective database was analyzed with the intent to identify risk factors for recurrence after TEM. Results Among 355 patients subjected to TEM, 107 had an adenocarcinoma: 48 pT1, 43 pT2, and 16 pT3. Comparing pre-and postoperative data, histological discrepancy was 20% and staging discrepancy was 34%. Mortality was nil, morbidity was 9%. Mean follow-up was 54.2 months (range = 12-164), follow-up rate was 100%. The 5-year disease-free survival rate was 85.9, 78.4, and 49.4% for pT1, pT2, and pT3, respectively (p = 0.006). Recurrence rate was 0% (0/26) in pT1sm1 cancers and 22.7% (5/22) in sm2-3 (p < 0.05). A submucosal infiltration represented a significant risk factor for recurrences: 0% sm1, 16.7% sm2, and 30% sm3. Recurrence in pT2 was 0% in patients who had neoadjuvant therapy and 26% in the others. At univariate analysis, diameter, sm stage, pT stage, tumor grading, margin infiltration, and lymphovascular invasion demonstrated statistical significance. Multivariate analysis indicated sm stage, pT stage, and tumor grading as independent predictors of recurrence. Conclusions TEM represents an effective curative treatment for pT1 sm1 rectal malignancies. pT1 sm2-3 patients should be considered high-risk cases if treated only by TEM. A consistent improvement in the preoperative assessment of the risk factors identified by the present study will be a crucial development for optimal treatment of early rectal cancers. Keywords Transanal endoscopic microsurgery Malignant rectal neoplasm Recurrence Risk factors The goal of oncological surgery is to achieve the best cancer control with preservation of function and quality of life. In the field of malignant rectal neoplasms, radical resection, consisting of anterior resection with total mesorectal excision (TME) when feasible and abdominoperineal resection (APR) when mandatory, represents the best curative treatment. Nevertheless, these procedures are burdened with a consistent morbidity rate, including genitourinary and sexual dysfunction (30-40%) [1][2][3][4], anastomotic leakage (5-17%) [5], and long-term functional bowel disturbance [6]. Up to 40% of patients experience perineal wound complications and long-term discomfort following APR, while stoma and stoma appliance-related complications occur in up to 66%. There is also significant psychological morbidity associated with change in body image and depression in 30% [7].A transanal approach to rectal malignant neoplasms, if suitable, would lower risks and improve functional results. Unfortunately, the conventional transanal excision is characterized by a high incidence of remnant disease or early recurrence [8,9]. For more than 25 years, transanal endoscopic microsurgery (TEM) had revolutionized the technique and outcome of transanal surgery, becoming the ...

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Section: Introductionmentioning

confidence: 99%

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

et al. 2011

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“…A transanal approach to rectal neoplasms by transanal endoscopic microsurgery (TEM)9–15, if amenable, could lower postoperative risks and improve functional results. To date, few studies16–20 have evaluated functional outcome after TEM, with the majority reporting only short‐term results based on manometry data.…”

Section: Introductionmentioning

confidence: 99%

Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome

Müller

Barrios

Kliemann

et al. 2010

Ultrasound in Obstet & Gyne

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“…Anterior resection and abdominoperineal resection (APR) are the usual operations for the treatment of large benign and malignant rectal tumours1, 2. An alternative is to perform local tumour resection, with its potential advantages of sphincter preservation even for patients with low rectal tumours, low mortality rate, minimal morbidity, and no functional disorders or risk of urinary or sexual dysfunction3–5.…”

Section: Introductionmentioning

confidence: 99%