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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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MORAES, Roberto da Silveira et al. Transanal endoscopic microsurgery and adjuvant therapy in the treatment of early rectal cancer. ABCD, arq. bras. cir. dig. [online]. 2011, vol.24, n.2, pp.113-120. ISSN 0102-6720.

BACKGROUND: The total mesorectal excision is considered the standard operation in the treatment of rectal tumors, although there is no scientific proof that it should be used for all stages of the disease. It has been demonstrated that in selected cases of rectal tumors, promising results can be achieved with local treatment by transanal endoscopic microsurgery. These tumors, called early rectal cancer, T1 tumors, are less than 4 cm, well differentiated without angiolymphatic invasion - pT1 SM1. As the risk of lymph node involvement in these tumors is approximately 3%, local resection would have a great chance to be curative. AIM: To present the results of a non-random prospective series of patients with early rectal cancer treated by transanal endoscopic microsurgery. METHODS: Between 2002 and 2010, 38 patients evaluated by preoperative protocol as patients with early rectal cancer underwent endoscopic microsurgical resection of the entire rectal wall including the tumor when located between 2 and 8 cm from the dentate line. The preoperative evaluation consisted of digital rectal examination, rigid sigmoidoscopy macrobiopsies, barium enema and/or colonoscopy, endorectal ultrasound and abdominal computed tomography of the abdomen, chest radiography and serum CEA. Was conducted follow-up with endoscopy and endorectal ultrasound every three months during the first two years, and every six in the next three years, and CEA every six months during the same period of five years. Was evaluated the tumor recurrence, morbidity and mortality. RESULTS: Pathologic evaluation considered 29 categorized as low risk and nine being high. The follow-up in the series ranged from one to seven years. Tumor recurrence was confirmed in two of the 38 cases (5.26%), in one the lesion was considered high and another low risk. CONCLUSION: Transanal endoscopic microsurgery associated or not to adjuvant therapy, may be, currently, considered the gold standard in local rectal resection, with encouraging results in cases chosen with early rectal tumors at low risk.

Keywords : Early rectal cancer; Local excision; Transanal endoscopic microsurgery; Adjuvant treatment.

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