Portal de Periódicos da CAPES

Site of local surgery in adenocarcinoma of the rectum T2 N0 M0

2009; Elsevier BV; Volume: 85; Issue: 2 Linguagem: Inglês

10.1016/s2173-5077(09)70123-1

2173-5077

Xavier Serra‐Aracil, Jordi Bombardó Juncá, Laura Mora, Manuel Alcántara Moral, Isidro Ayguavives Garnica, Ana Darnell Martín, Alex Casalots Casado, Carles Pericay Pijaume, Rafael Campo Fernández de los Ríos, Salvador Navarro,

Colorectal Cancer Screening and Detection

The local exeresis adenocarcinoma of the rectum T2 N0 M0 (ADC-T2), using transanal endoscopic microsurgery (TEM), has the benefit of achieving lower morbidity with a better quality of life. However, local occurrence of the local exeresis is greater than 20%, which is unacceptable these days. Prospective, observational follow up study. The tumours committee agreed that those ADC-T2 patients could have the following treatments: total mesorectal excision (TME), simple TEM, TEM with postoperative chemo-and radiotherapy (Ct-Rt), preoperative Ct-Rt with subsequent TEM, and radical surgical rescue (TME) within at least 4 weeks. Of the 146 patients operated on using TEM, 75 had adenocarcinomas, 59 adenomas, 6 scarring wounds, 5 carcinoids, and 1 GIST. Of the adenocarcinomas 22 were ADC-T2. Follow up: median of 16 months (range, 3–32 months). The overall local recurrence was 18% (4/22). According to the treatment strategy the local occurrence was: TEM as the only procedure, 20% (2/10). Radical surgical rescue was performed on 3 patients after TEM, with no local or systemic recurrences. TEM with Qt-Rt after surgery was performed on 6 patients, with a local recurrence of 33% (2/6). Ct-Rt and subsequent TEM in 3 patients, with no local or systemic recurrences. Treatment of ADC-T2 using simple TEM is not effective. The combination of Ct-Rt after TEM, does not improve the results of TME. It is possible to rescue those patients without changing the overall survival. Preoperative Ct-Rt and TEM appears to be the approach that obtains a clinical and histological response, although a response is needed by clinical trials. La exéresis local del adenocarcinoma de recto T2N0M0 (ADC-T2), mediante microcirugía endoscópica transanal (TEM), se beneficia en conseguir una menor morbilidad con mejor calidad de vida. Sin embargo, la recidiva local de la exéresis local es superior al 20%, inaceptable en estos momentos. Estudio observacional de seguimiento prospectivo. Los pacientes ADCT2 son consensuados en el comité de tumores a las actuaciones terapéuticas: escisión total del mesorrecto (ETM), TEM simple, TEM con quimiorradioterapia (Qt-Rt) postoperatoria, Qt-Rt preoperatoria con posterior TEM y rescate a cirugía radical (ETM) en menos de 4 semanas. Se ha intervenido a 146 pacientes mediante TEM; 75 adenocarcinomas, 59 adenomas, 6 lesiones cicatriciales, 5 carcinoides y 1 GIST. De los adenocarcinomas, 22 fueron ADC-T2. Seguimiento: mediana, 16 (intervalo, 3–32) meses. La recidiva local total ha sido del 18% (4/22). Según la estrategia terapéutica la recidiva local fue: TEM como único procedimiento en el 20% (2/10). Se realizó en 3 pacientes rescate a cirugía radical tras TEM, sin recidiva local ni sistémica. TEM con Qt-Rt posterior a la cirugía se realizó en 6, con una recidiva local del 33% (2/6). Se practicó Qt-Rt y posteriormente TEM en 3 pacientes, sin recidiva local ni sistémica. El tratamiento del ADC-T2 mediante TEM simple no es razonable. La asociación de Qt-Rt tras TEM, no consigue mejorar los resultados a la ETM. Es factible rescatar a los pacientes sin que altere la supervivencia total. La Qt-Rt preoperatoria y TEM parece ser la línea cuando se consiga una respuesta histológica y clínica, aunque es necesaria la respuesta por parte de ensayos clínicos.