Assuntos
Humanos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Proctoscopia/efeitos adversos , Cirurgia Endoscópica Transanal/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Dor Pós-Operatória , Complicações Pós-Operatórias/classificação , Transtornos Urinários/etiologia , Incidência , Morbidade , Perda Sanguínea Cirúrgica , Proctoscopia/métodos , Fístula Retovaginal/etiologia , Hemorragia Pós-Operatória/etiologia , Constrição Patológica/etiologiaRESUMO
Endoscopic mucosal resection and surgery have been the treatments used for resection of early neoplastic colorectal lesions. However, since a few years ago the endoscopic submucosal dissection is a procedure accepted for the curative treatment of these lesions. Among the complications that can occur with this procedure, perforation is one of the most serious ones, requiring in most cases surgical management. A case is reported of a sixty-year-old male patient diagnosed with an extensive flat colorectal polyp, who underwent an endoscopic submucosal dissection, with the subsequent complications of a perforation with subcutaneous emphysema and extra peritoneal air. In conjunction with the surgical team, a decision was made to apply a conservative medical treatment based on suspension of the oral intake and antibiotic therapy, yielding good clinical and imaging evolution.
Assuntos
Dissecação/efeitos adversos , Mucosa Intestinal/cirurgia , Perfuração Intestinal/etiologia , Proctoscopia/efeitos adversos , Reto/lesões , Idoso , Humanos , Mucosa Intestinal/lesões , Perfuração Intestinal/terapia , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Significant tumor downstaging among patients with rectal cancer following neoadjuvant chemoradiation has raised the issue of offering patients with small residual cancers restricted to the bowel wall an alternative treatment strategy to total mesorectal excision. Transanal endoscopic microsurgery may allow proper primary tumor resection with promising oncological outcomes, less postoperative morbidity, and minimal long-term sexual, urinary, and fecal continence disorders in comparison with radical resection. OBJECTIVE: The aim of this study was to determine the oncological outcomes of patients with residual rectal cancers restricted to the rectal wall (ypT0-2) following neoadjuvant chemoradiation and transanal endoscopic microsurgery. DESIGN: This study considered a prospective cohort of patients with residual rectal cancers following neoadjuvant chemoradiation treated by transanal endoscopic microsurgery and no additional systemic therapy. SETTINGS: This study was a single-institution experience. PATIENTS: Patients with adenocarcinoma of the rectum located no more than 7 cm from the anal verge and endorectal ultrasound- or magnetic resonance-staged cT2-4N0-2M0 treated by neoadjuvant chemoradiation (50.4-54 Gy and 5-fluorouracil-based chemotherapy) were eligible for the study. Patients with small residual tumors (≤3 cm) radiologically staged ycT0-2N0 were treated by transanal endoscopic microsurgery. INTERVENTIONS: Transanal endoscopic microsurgery was performed. MAIN OUTCOME MEASURES: The primary outcome measured was local recurrence. RESULTS: Of the 27 patients treated by transanal endoscopic microsurgery, 3 had ypT0, 6 had ypT1, and 18 had ypT2 cancers. All patients underwent R0 transanal endoscopic microsurgery excision. Local recurrence was observed in 4 (15%) patients after a median follow-up of 15 months. Only lymphovascular invasion was an independent predictive factor for local failure (p = 0.04). Tumor size, ypT status, T-status downstaging, lateral/radial margins, and tumor regression grade were not predictors of local failure. LIMITATIONS: This study was limited by the small sample size and limited follow-up. CONCLUSIONS: A local failure rate of 15% after transanal endoscopic microsurgery for patients with residual rectal cancers restricted to the bowel wall (ypT0-2) may limit the indication of this procedure to highly selected patients as an alternative to standard radical total mesorectal excision.
Assuntos
Adenocarcinoma , Canal Anal/cirurgia , Microcirurgia , Complicações Pós-Operatórias/epidemiologia , Proctoscopia , Neoplasias Retais , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Brasil/epidemiologia , Quimiorradioterapia/métodos , Feminino , Fluoruracila/uso terapêutico , Humanos , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasia Residual , Avaliação de Resultados em Cuidados de Saúde , Proctoscopia/efeitos adversos , Proctoscopia/métodos , Proctoscopia/estatística & dados numéricos , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Medição de Risco , Análise de SobrevidaRESUMO
RACIONAL: A literatura médica aceita ressecção local como opção válida em casos selecionados de tumores de reto. A seleção dos pacientes requer exata estimativa dos riscos e avaliação pré-operatória precisa, tanto no aspecto clínico como histopatológico. OBJETIVO: Avaliar os resultados da microcirurgia endoscópica transanal em seguimento de 18 meses. MÉTODOS: De abril de 2002 a abril de 2006, 50 pacientes com tumores de reto foram submetidos a microcirurgia endoscópica transanal, selecionados por suas características clínicas e histopatológicas. Os critérios de inclusão foram: adenomas sésseis maiores do que 3 cm e menores do que 8 cm não-circunferenciais; neoplasia intra-epitelial de alto grau; carcinoma retal pT1, e em casos especiais pT2. Todos esses tumores foram submetidos ao mesmo procedimento cirúrgico. RESULTADOS: O resultado histopatológico final revelou 9 adenomas, 26 neoplasias intra-epiteliais de alto grau, 13 carcinomas (9 pT1 e 4 pT2) e 2 carcinóides. A menor idade foi de 25 anos e a maior de 92. O menor tumor ressecado tinha 64 mm² (carcinóide) e o maior (adenoma) 90 mm². O tempo médio de operação foi de 90 minutos e o de internamento 5 dias. Houve uma morte não relacionada ao método. Um paciente com carcinoma de baixo risco pT1 apresentou recidiva 18 meses após microcirurgia endoscópica transanal e foi submetido a retossigmoidectomia curativa. Foi observado tumor residual em dois pacientes e a complicação mais grave foi uma fístula retovaginal. A taxa de complicação global foi de 9 por cento. CONCLUSÃO: Atualmente a microcirurgia endoscópica transanal é a técnica de escolha para o tratamento de adenomas sésseis, neoplasias intra-epiteliais de alto grau e carcinoma retal pT1 de baixo risco.
BACKGROUND: The medical literature accepts local resection as a valuable option in selected cases of rectal tumors. Selection of patients requires an exact perioperative estimation of risks with clinical and histopathological examination. Transanal endoscopic microsurgery aims a safe resection of the tumoral area which leads up to the cure. AIM: To evaluate transanal endoscopic microsurgery results in a follow-up time of 18 months. METHODS: From April 2002 to April 2006, 50 patients with rectal tumors were submitted to transanal endoscopic microsurgery, chosen by clinical history and lesion characteristics. The inclusion criteria were: sessile adenomas larger than 3 cm and smaller than 8 cm, not circumferentially distributed; intra epithelial neoplasia of high degree; and rectal carcinoma pT1, and special cases of pT2. All these rectal tumors were submitted to the same surgical act. RESULTS: The final histopathological results reveal 9 adenoma, 26 intra-epithelial neoplasia of high degree, 13 carcinoma (9 pT1-4 pT2) and 2 carcinoid. The lowest age was 25 and the higher, 92 years-old. The smallest resected tumor had 64 mm² (carcinoid) and the largest (adenoma), 90 cm². Operating time was in average 90 minutes and the overall time statement, 5 days. There was one death not related with the method. One patient with low risk carcinoma pT1 presented recurrence 18 months after transanal endoscopic microsurgery and was submitted to curative rectosigmoidectomy. It was proven a residual tumor after local surgery in two patients and the most important complication was one recto-vaginal fistula. The overall complications rate was 9 percent. CONCLUSION: Today transanal endoscopic microsurgery is chosen as the ideal technique for the treatment of sessile adenomas, intraepithelial neoplasia of high degree and rectal carcinoma pT1.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Adenoma/cirurgia , Carcinoma/cirurgia , Microcirurgia/métodos , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Canal Anal , Adenoma/patologia , Carcinoma/patologia , Seguimentos , Microcirurgia/efeitos adversos , Recidiva Local de Neoplasia , Neoplasia Residual , Estudos Prospectivos , Proctoscopia/efeitos adversos , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Resultado do TratamentoRESUMO
PURPOSE: The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. METHODS: The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. RESULTS: The results were favorable and equivalent to those described in the literature. CONCLUSIONS: The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.
Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Canal Anal/cirurgia , Proctoscópios/normas , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Desenho de Equipamento , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Recidiva Local de Neoplasia/etiologia , Proctoscopia/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The medical literature accepts local resection as a valuable option in selected cases of rectal tumors. Selection of patients requires an exact perioperative estimation of risks with clinical and histopathological examination. Transanal endoscopic microsurgery aims a safe resection of the tumoral area which leads up to the cure. AIM: To evaluate transanal endoscopic microsurgery results in a follow-up time of 18 months. METHODS: From April 2002 to April 2006, 50 patients with rectal tumors were submitted to transanal endoscopic microsurgery, chosen by clinical history and lesion characteristics. The inclusion criteria were: sessile adenomas larger than 3 cm and smaller than 8 cm, not circumferentially distributed; intra epithelial neoplasia of high degree; and rectal carcinoma pT1, and special cases of pT2. All these rectal tumors were submitted to the same surgical act. RESULTS: The final histopathological results reveal 9 adenoma, 26 intra-epithelial neoplasia of high degree, 13 carcinoma (9 pT1-4 pT2) and 2 carcinoid. The lowest age was 25 and the higher, 92 years-old. The smallest resected tumor had 64 mm(2) (carcinoid) and the largest (adenoma), 90 cm(2). Operating time was in average 90 minutes and the overall time statement, 5 days. There was one death not related with the method. One patient with low risk carcinoma pT1 presented recurrence 18 months after transanal endoscopic microsurgery and was submitted to curative rectosigmoidectomy. It was proven a residual tumor after local surgery in two patients and the most important complication was one recto-vaginal fistula. The overall complications rate was 9%. CONCLUSION: Today transanal endoscopic microsurgery is chosen as the ideal technique for the treatment of sessile adenomas, intraepithelial neoplasia of high degree and rectal carcinoma pT1.
Assuntos
Adenoma/cirurgia , Carcinoma/cirurgia , Microcirurgia/métodos , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Carcinoma/patologia , Seguimentos , Humanos , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasia Residual , Proctoscopia/efeitos adversos , Estudos Prospectivos , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Resultado do TratamentoRESUMO
PURPOSE: The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. METHODS: The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. RESULTS: The results were favorable and equivalent to those described in the literature. CONCLUSIONS: The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.(AU)
INTRODUÇÃO: A operação cirúrgica por acesso transanal no tratamento do câncer retal é uma das várias técnicas utilizadas nessa terapêutica. Há várias técnicas de excisão local para os tumores retais: O método cirúrgico transanal convencional, acessos posteriores, colonoscopia terapêutica e operações transanais endoscópicas. O objetivo é apresentar um novo método de ressecção transanal endoscópica (Operação Transanal Endoscópica - OTE), realizada com um proctoscópio cirúrgico idealizado para o procedimento e divulgar os resultados obtidos em 32 pacientes submetidos a OTE e compará-los com as técnicas atualmente empregadas. MÉTODOS: Foram analisadas as proporções médias da recorrência, das complicações pós-operatórias e das ressecções posteriores por meio da técnica de metanálise. Para a distância e o tamanho das lesões retais, os tempos de operação e de hospitalização, foram feitos gráficos de acordo com o autor e a técnica. RESULTADOS: Os resultados foram favoráveis e equiparáveis aos trabalhos analisados. CONCLUSÃO: Concluiu-se que: O proctoscópio utilizado na OTE demonstrou ser eficaz e de baixo custo; 2 - A OTE mostrou-se factível; 3 - A análise dos resultados com a OTE foram satisfatórios e similares às outras técnicas de ressecções transanais endoscópicas que são de alto custo e pouco disponíveis em nosso meio.(AU)
Assuntos
Humanos , Adenocarcinoma/cirurgia , Adenoma/cirurgia , Proctoscópios/normas , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Desenho de Equipamento , Seguimentos , Tempo de Internação/estatística & dados numéricos , Recidiva Local de Neoplasia/etiologia , Proctoscopia/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. METHODS: The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. RESULTS: The results were favorable and equivalent to those described in the literature. CONCLUSIONS: The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.
INTRODUÇÃO: A operação cirúrgica por acesso transanal no tratamento do câncer retal é uma das várias técnicas utilizadas nessa terapêutica. Há várias técnicas de excisão local para os tumores retais: O método cirúrgico transanal convencional, acessos posteriores, colonoscopia terapêutica e operações transanais endoscópicas. O objetivo é apresentar um novo método de ressecção transanal endoscópica (Operação Transanal Endoscópica - OTE), realizada com um proctoscópio cirúrgico idealizado para o procedimento e divulgar os resultados obtidos em 32 pacientes submetidos a OTE e compará-los com as técnicas atualmente empregadas. MÉTODOS: Foram analisadas as proporções médias da recorrência, das complicações pós-operatórias e das ressecções posteriores por meio da técnica de metanálise. Para a distância e o tamanho das lesões retais, os tempos de operação e de hospitalização, foram feitos gráficos de acordo com o autor e a técnica. RESULTADOS: Os resultados foram favoráveis e equiparáveis aos trabalhos analisados. CONCLUSÃO: Concluiu-se que: O proctoscópio utilizado na OTE demonstrou ser eficaz e de baixo custo; 2 - A OTE mostrou-se factível; 3 - A análise dos resultados com a OTE foram satisfatórios e similares às outras técnicas de ressecções transanais endoscópicas que são de alto custo e pouco disponíveis em nosso meio.
Assuntos
Humanos , Adenocarcinoma/cirurgia , Adenoma/cirurgia , Canal Anal/cirurgia , Proctoscópios/normas , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Desenho de Equipamento , Seguimentos , Tempo de Internação/estatística & dados numéricos , Recidiva Local de Neoplasia/etiologia , Proctoscopia/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
En el presente trabajo se han estudiado 40 personas concurrentes al servicio de Gastroenterología del Hospital Hipólito Unanue. Se tomaron una muestra basal de sangre y muestras sucesivas al minuto, cinco, diez y quince minutos después de realizada la Proctosigmidoscopía, con jeringa y aguja descartable para cada muestra. El análisis de los hemocultivos demuestra que en todos los casos el hemocultivo basal, fue negativo, de los hemocultivos posteriores a la endoscopía, 5 casos correspondieron a Estafilococo Aureus, coagulasa negativo; un caso de Neisseria y un caso de Difteroide. De los 7 hemocultivos positivos, dos lo fueron en la segunda muestra, dos casos en la tercera y los tres restantes en la cuarta muestra. No hubo positividad en la quinta muestra. La positividad de los hemocultivos nos lleva a concluir que se presenta bacteriemia como posible complicación del exámen proctosigmoidoscópico, pero con la característica especial de ser transitoria, de corta duración, ya que se presenta sólo en los primeros minutos de realizado el examen, encontrándose la sangre, libre de bacterias, quince minutos después de la endoscopía.