[Transanal endoscopic operations for rectal tumours]. / Cirugía endoscópica transanal en tumores rectales.

BACKGROUND: Transanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. METHODS: In this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery,…). RESULTS: The indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery. All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. CONCLUSIONS: TEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation.

Cirugía endoscópica transanal en tumores rectales / Transanal endoscopic operations for rectal tumours

INTRODUCCIÓN: La cirugía endoscópica transanal puede ser la técnica de elección para el tratamiento de las lesiones rectales, tanto benignas como malignas seleccionadas, con cifras de supervivencia equiparables a la cirugía convencional y tasas de morbilidad más bajas. MÉTODOS: Presentamos una serie de 70 pacientes intervenidos por operación endoscópica transanal (TEO); las indicaciones fueron lesiones rectales benignas o malignas en estadio precoz (T1) 86%. La cirugía se instrumentó con un sistema TEO (Karl Storz, Tüttlingen, Alemania) y bisturí armónico (Harmonic scalpel, Ethicon Endo-Surgery). RESULTADOS: En 43 pacientes la indicación fue lesión adenomatosa; en los 27 restantes el diagnóstico preoperatorio fue de adenocarcinoma. Sin embargo, tras la resección, 47% mostraron lesión maligna en el resultado anatomopatológico, incluyendo 13 de los 43 considerados inicialmente como benignos. La morbilidad postoperatoria global fue del 36%, Clavien III (5,7%), precisando reintervención inmediata 3 (4%). Todas las lesiones benignas se resecaron de forma completa y 7 malignas presentaron afectación del margen de resección. Con un seguimiento medio de 26,4 meses (1-71), la recidiva para tumores benignos ha sido del 9% para pT1 del 8% y, para pT2, del 12,5%. Precisaron nueva cirugía 8 pacientes. CONCLUSIONES: La TEO permite extirpar tumores benignos de recto no resecables mediante resección endoscópica o transanal con un bajo índice de morbilidad. También está indicada en el tratamiento curativo de las neoplasias malignas de recto que se confirman histológicamente como carcinomas pT1 de buen pronóstico

BACKGROUND: Transanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. METHODS: In this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery,...).RESULTS: The indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery. All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. CONCLUSIONS: TEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation