Publication: Resección local transanal endoscópica de tumores rectales
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2017-09-06
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Universidad Complutense de Madrid
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Abstract
La microcirugía endoscópica transanal (TEM) ha cambiado radicalmente la forma de entender el tratamiento de la patología tumoral del recto. La resección radical del recto ha sido durante años la única alternativa para pacientes con tumores rectales. La cirugía radical del recto tiene buenos resultados oncológicos a largo plazo, pero se acompaña de importantes complicaciones postoperatorias y un riesgo de mortalidad no despreciable. Además en muchas ocasiones se precisa de la realización de un estoma. Con el objetivo de evitar la morbimortalidad postoperatoria de la cirugía radical del recto, así como los problemas funcionales derivados de la misma, algunos pacientes seleccionados con tumores rectales cercanos al ano han sido sometidos a resección local por vía transanal directa o transperineal con resultados desalentadores en cuanto a recidivas y morbilidad a corto y largo plazo. La cirugía mediante TEM comenzó siendo una técnica indicada para pequeños tumores rectales localizados en el recto extraperitoneal y se ha ido extendiendo a tumores cada vez de mayor tamaño, más altos y más avanzados, con resultados dispares según las series. La literatura actual avala la resección local mediante TEM para tumores benignos o tumores malignos localizados del recto (T0 N0 – T1 N0). Sin embargo, las limitaciones técnicas y de disponibilidad en muchos centros hace que muchos pacientes sean sometidos a cirugía radical por esta patología...
The transanal endoscopic microsurgery (TEM) has radically changed the way of understanding the treatment of rectal tumor pathology. Radical resection of the rectum has been for years the only alternative for patients with rectal tumors. Radical surgery rectal cancer have good long-term results, but is associated with significant postoperative complications and risk of mortality. In addition often it is required for performing a stoma. In order to avoid postoperative morbidity of radical surgery of the rectum as well as functional problems, some selected with rectal tumors near the anus patients have undergone local excision by transanal directly or transperineal approach. Results in morbidity and recurrences are discouraging short and long term. TEM surgery began as a technique suitable for small rectal tumors located in the extraperitoneal rectum and has been extended to tumors growing larger, higher and more advanced, with varying results depending on the series. Current literature supports local excision by TEM for benign or localized malignant tumors of the rectum (T0 N0 - T1 N0). However, technical limitations and the availability in many centers means that many patients undergo radical surgery for this condition...
The transanal endoscopic microsurgery (TEM) has radically changed the way of understanding the treatment of rectal tumor pathology. Radical resection of the rectum has been for years the only alternative for patients with rectal tumors. Radical surgery rectal cancer have good long-term results, but is associated with significant postoperative complications and risk of mortality. In addition often it is required for performing a stoma. In order to avoid postoperative morbidity of radical surgery of the rectum as well as functional problems, some selected with rectal tumors near the anus patients have undergone local excision by transanal directly or transperineal approach. Results in morbidity and recurrences are discouraging short and long term. TEM surgery began as a technique suitable for small rectal tumors located in the extraperitoneal rectum and has been extended to tumors growing larger, higher and more advanced, with varying results depending on the series. Current literature supports local excision by TEM for benign or localized malignant tumors of the rectum (T0 N0 - T1 N0). However, technical limitations and the availability in many centers means that many patients undergo radical surgery for this condition...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 13-01-2016