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Year 2010 Vol. 18 No 1

ONCOLOGY

V. JOTAUTAS, E. POSKUS, P. ZEROMSKAS, D. SEININ, K. STRUPAS

TREATMENT OF RECTAL TUMOURS WITH TRANSANAL ENDOSCOPIC MICROSURGERY: SIX YEAR’S EXPERIENCE IN LITHUANIA

Vilnius University Hospital «Santariskiu Klinikos» ,
National Center of Pathology ,
Lithuania

Objective. The aim of this study is to assess six year’s experience gained in Lithuania while treating rectal tumours with transanal endoscopic microsurgery in the Centre of Abdominal Surgery of the Vilnius University Hospital «Santariskiu Klinikos».
Materials and methods. Patients having rectal adenomas and low-risk malignant tumours of stage T1, good or medium differentiation, with no lymphatic and vascular invasion were chosen for operations. The stage of the tumour has been determined before the operation after transanal endosonoscopy, MRI and rectoscopy with multiple macrobiopsies.
Results. 155 patients were operated, 161 TEM were performed and 172 tumours were removed. The median size of tumours was 3, 17±1,93 cm (ranged from 0,3 to 12 cm). Overall 60 (33,7%) malignant tumours and 106 (59,9%) adenomas were removed. Pre-operative and final clinical diagnoses did not coincide for 24 patients (13,9%). 154 (89,5%) radical operations (R0), 1 (0,6%) not radical (R1) and 17 (9,9%) operations of unknown radicality (RX) were performed. Three (1,9%) complication were observed. After the removal of nine Ca T2 five patients underwent adjuvant radiotherapy. 132 patients were followed-up for 2–44 months after the operation. Two (1,2%) recurrence of a tubulovillous adenoma and one of a CaTis (0,6%) was diagnosed. No other complications were reported.
Conclusions. The results of transanal endoscopic microsurgery obtained while treating rectal adenomas and low-risk T1 cancers are good. The low rate of complications and recurrences in this group offers much hope. The experience of the treatment of T2 cancers with transanal endoscopic microsurgery and adjuvant radiotherapy is limited but the results are encouraging. The results of randomised and controlled trials need to be awaited before definite conclusions can be drawn.

Keywords: rectal tumours, minimally invasive surgery, transanal endoscopic microsurgery
p. 67 – 74 of the original issue
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