Izvorni znanstveni članak
Transanal Endoscopic Microsurgery (TEM) – Alternative or a Method of Choice in Treating Tumors of the Rectum with Appropriately Selected Patients?
Đordano Bačić
; Department of Digestive Surgery, University hospital Rijeka, Rijeka, Croatia
Iva Durut
; Department of Digestive Surgery, University hospital Rijeka, Rijeka, Croatia
Nado Bukvić
; Department of Pediatric Surgery, University Hospital of Rijeka, Rijeka, Croatia
Ivica Čepić
; Department of Digestive Surgery, University hospital Rijeka, Rijeka, Croatia
Sažetak
TEM is an endoscopic method of operating tumors up to 18 cm of the anal verge. It enables procedures from a simple
mucosectomy to en-block excisions of the whole thickness of the rectal wall. We present a study in which we evaluated
surgical morbidity, mortality and recurrence rate of rectal tumors in patients treated with TEM from July 2007, up to the
end of March 2014. In our Department 129 patients were treated by TEM and 123 of them (74 men and 49 women) had
rectal tumors: 55 adenomas, 36 cancers in situ (Tis), 15 T1, 9 T2, 4 T3 (3 palliative, and 1 underwent salvage operation)
and 4 T4 (all palliative) rectal cancers. 6/123 patients were treated with TEM after the fi nding of metachronic recurrences
that emerged after previously performing major surgery. In 3/123 cases (2.44%) the resection margins were positive.
The overall local recurrence rate was 19(15.45%) – adenoma 6/55 (10.91%), Tis 4/36(11.11%), T1 0/15(0%), T2 4/9(44.44%),
T3 1/4(25%), T4 4/4(100%), respectively. In 2 patients the illness was subsequently disseminated, and in 7 patients it was
widespread at the time of surgery. Nine (7.31%) patients died during follow-up due to disease dissemination. Minor complications
occurred in 24 patients (19.51%) whereas we had no major complications and no early postoperative mortality.
The average postoperative hospital stay is 2.3 days. TEM is a safe and appropriate surgical treatment option for benign
rectal tumors and for early-stage rectal carcinomas. TEM is also good as a palliative method, and it’s useful for elderly
and unfi t patients.
Ključne riječi
transanal endoscopic microsurgery (TEM); adenoma; cancer in situ (Tis); rectal cancer; recurrence
Hrčak ID:
147404
URI
Datum izdavanja:
26.12.2014.
Posjeta: 641 *