[Transanal endoscopic microsurgery in the treatment of rectal tumors: a prospective study in 50 patients].
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.


OBJECTIVE
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%.


CONCLUSIONS
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.
Moraes
Roberto da Silveira
Rda S
Serviço de Cirurgia do Aparelho Digestivo, UFPR, Curitiba, PR. rdsmoraes@ig.com.br
Malafaia
Osvaldo
O
Telles
José Ederaldo Queiroz
JE
Trippia
Marcus Adriano
MA
Buess
Gerhard F
GF
Coelho
Júlio Cezar Uilli
JC
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome