Author/Editor		Velnić, Davorin; Tomičić, Milan; Košuta, Dragutin; Čala, Zoran; Rukavina, Jerko
Title		Transanal endoscopic microsurgery for treatment of early rectal carcinoma
Translated title		Transanalna endoskopska mikrokirurgija pri zgodnjem raku danke
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 3, št. 5
Publication year		1998
Volume		str. 29-33
Language		eng
Abstract		The recent understandings of tumor pathophysiology, as well as the development of new surgical procedures have encouraged surgeons to apply minimally invasive techniques to the treatment of certain types of rectal tumors. From March 1993 to May 1997, transanal endoscopic microsurgery was used in 46 patients; the Parks retractors were empoyed in 2 patients. Postoperative histological diagnosis of carcinoma was established in 18 patients; 5 patients had carcinoma in situ, 10 pT1 carcinoma, 2 pT2 and one patient pT3 lesion according to the TNM classification. Patients with pT2 and pT3 lesions were additionally treated by radical surgery. Other patients had a histological diagnosis of adenoma. They were followed up for 6 to 54 months. Apart from one conversion, there were no other operative complications. Metastatic spread was seen in one patient with T3 carcinoma 18 months after radical surgery. Two patients (4.2%) developed local recurrence 12 and 18 months after the operation, respectively. A minimally invasive approach has gained acceptance as a treatment option in selected patients with rectal carcinoma. A careful preoperative pathological examination and evaluation by endoluminal ultrasonography are necessary before considering this treatment modelity. Local therapy of rectal carcinoma is indicated in pT1 lesions and histologically low-risk tumors (G1, G2). Implementation of strict selection criteria ensures acceptability of this treatment from an oncological point of view.
Summary		Najnovejša spoznanja o patofiziologiji tumorjev in razvoj novih kirurških tehnik so botrovala uvedbi minimalno invazivnega zdravljenja nekaterih tumorjev danke. Od marca 1993 do maja 1997 smo zdravili 46 bolnikov s transanalno endoskopsko mikrokirurgijo in dva bolnika ob pomoči dveh Parksovih retraktorjev. Rakaste celice so bile najdene pri histološkem pregledu resektata pri 18 bolnikih. Pri petih bolnikih smo našli carcinoma in situ, pri 10 bolnikih pT1, pri 2 pT2 in pri 1 bolniku pT3 po TNM klasifikaciji. Bolniki s pT2 in pT3 tumorji so bili dodatno radikalno operirani. Pri ostalih bolnikih smo našli adenome. Bolnike smo spremljali od 6 - 54 mesecev. Razen enega preklopa (konverzije) ni bilo zapletov. Metastaze so se pojavile pri enem bolniku s T3 tumorjem 18 mesecev po radikalni operaciji. Pri dveh bolnikih smo ugotovili lokalno ponovitev 12 in 18 mesecev po posegu (4,2%). Minimalno invazivno zdravljenje izbranih primerov raka danke izgleda upravičeno. Zanesljiva predoperacijska zamejitev z endoluminalnim ultrazvokom in patohistološka klasifikacija sta najpomembnejši pri postavljanju indikacije za tovrstvno zdravljenje. Za lokalno zdravljenje so primerni rakasta obolenja danke pT1 in histološko tumorji z nizkim tveganjem (G1, G2). Če upoštevamo ta merila, je takšno zdravljenje tudi onkološko sprejemljivo.
Descriptors		RECTAL NEOPLASMS SURGERY, LAPAROSCOPIC ANUS TREATMENT OUTCOME