Fwd: What's new for 'Actualización TEM' in PubMed

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Asunto: What's new for 'Actualización TEM' in PubMed
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Sender's message: Nueva BibliografÃa del TEM
Sent on Monday, 2011 Aug 01
Search "Rectum"[Mesh] OR "Rectal Neoplasms"[Mesh] AND "Microsurgery"[Mesh]
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PubMed Results
Items 1 - 5 of 5

1. Arch Surg. 2011 May;146(5):544.
Rectal cancer: the good, the bad, and the ugly.
Pricolo VE.
Source
Department of Surgery, Rhode Island Hospitalâ€“Brown University, Providence, Rhode Island 02905, USA. vpri...@usasurg.org
Comment on
Arch Surg. 2011 May;146(5):540-3.
PMID:

21739653
[PubMed - indexed for MEDLINE]
Related citations

2. Hepatogastroenterology. 2011 Mar-Apr;58(106):364-8.
TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis.
Wu Y, Wu YY, Li S, Zhu BS, Zhao K, Yang XD, Xing CG.
Source
Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, China.
Abstract
BACKGROUND/AIMS:
To compare transanal endoscopic microsurgery (TEM) with conventional radical surgery (CRS) for T1 rectal cancer focusing on safety, feasibility and efficacy of both procedures.
METHODOLOGY:
An online search of Ovid, Medline, Embase, Pubmed and Cochrane Controlled Trials Register was undertaken to identify studies comparing TEM with CRS published in English between 1984 and March 2010. Only studies comparing TEM with CRS for T1 rectal cancer treatment and with a minimum of 20 cases were included. The parameters compared were postoperative complications, hospital mortality, recurrence rate and 5-year survival.
RESULTS:
Five studies met screening criteria and 397 patients were enrolled in the meta-analysis; 216 were treated with TEM and the rest received CRS. Complications were observed in 16/196 in the TEM group and 77/163 in the CRS group. The difference was significant (p=0.01). The rate of mortality was 3.68% in CRS group, and 0 in TEM group (p=0.01). The 5-year survival was similar (p=0.84), the TEM group was 80.1% and the CRS group was 81.0%. However, there was more recurrence in the TEM group compared to CRS group (p=0.0004). TEM group was 12.0%, while CRS group was 0.5%.
CONCLUSION:
Compared with CRS, TEM had significant shorter hospital stay and fewer postoperative complications. TEM is a safe, feasible and effective option for T1 rectal cancer. Though TEM had a slightly higher rate of recurrence than CRS, no significant difference on 5-year survival was observed.
PMID:

21661397
[PubMed - indexed for MEDLINE]
Related citations
3. Arch Surg. 2011 May;146(5):540-3.
Determining the need for radical surgery in patients with T1 rectal cancer.
Salinas HM, Dursun A, Klos CL, Shellito P, Sylla P, Berger D, Bordeianou L.
Source
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Comment in
Arch Surg. 2011 May;146(5):544.
Abstract
HYPOTHESIS:
In the era of modern preoperative staging of patients with rectal cancer, lymph node metastases can be reliably predicted by the histological features of the tumor and preoperative imaging. Local resection can then be safely offered to the patients who are at low risk of having malignant lymph nodes.
DESIGN:
We reviewed the records of 109 consecutive patients with preoperative imaging results suggestive of T1N0 or T2N0 disease who underwent total mesorectal excision. All patients underwent preoperative endorectal ultrasonography or magnetic resonance imaging and computed tomography, with or without positron emission tomography. Final pathologic investigation identified T3 disease in 27 patients. History, physical examination results, and radiologic and pathologic data were evaluated for predictors of positive nodes in the remaining 82 patients.
SETTING:
Tertiary care referral center.
PATIENTS:
Patients with preoperative imaging suggestive of T1N0 or T2N0 rectal cancer.
MAIN OUTCOME MEASURES:
To evaluate different clinical and pathologic tumor features as predictors of positive lymph nodes in T1 and T2 rectal cancers with negative radiographic nodes.
BACKGROUND:
Local resection of T1 and T2 rectal cancer results in lower morbidity compared with radical resection. However, recurrence rates after local resection are higher, likely owing to unresected nodal metastasis. Reports on predictors of lymph node metastasis remain inconsistent in the literature. Although local resection may be appropriate for some rectal cancers, selection criteria remain unclear.
RESULTS:
Despite indications of negative nodes on radiographic examination, 4 of 35 patients with T1 disease (11%) and 13 of 47 with T2 disease (28%) had positive nodes. On univariate analysis, the only significant predictor was depth of invasion: 24 of 65 patients with negative nodes (37%) vs 13 of 17 patients with positive nodes (76%) had tumors invading the lower third of the submucosa and beyond (P = .02). On logistic regression analysis accounting for depth of invasion (lower third of the submucosa and beyond), size, distance from anal verge, differentiation, and lymphovascular and small-vessel invasion, only depth of invasion remained a significant predictor.
CONCLUSIONS:
In all, 89% of patients with T1 disease (31 of 35) and 72% of those with T2 disease (34 of 47) underwent unnecessary radical resection. Endorectal ultrasonography or magnetic resonance imaging and computed tomography, with or without positron emission tomography, for preoperative staging could not identify these patients reliably. In addition, histologic markers of aggressive disease were not helpful. Thus, local resection for T2 rectal cancer is not justified. Local resection should be offered only to patients with superficial T1 tumors who will adhere to aggressive postoperative surveillance.
PMID:

21576608
[PubMed - indexed for MEDLINE]
Related citations

4. Int J Colorectal Dis. 2011 Apr;26(4):437-43. Epub 2011 Jan 27.
Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results.
Ramirez JM, Aguilella V, Valencia J, Ortego J, Gracia JA, Escudero P, Esco R, Martinez M.
Source
Department of Colorectal Surgery, University Hospital, Zaragoza, Spain. jram...@unizar.es
Abstract
PURPOSE:
Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention.
METHODS:
In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment.
RESULTS:
After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%.
CONCLUSIONS:
Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.
PMID:

21271346
[PubMed - indexed for MEDLINE]
Related citations

5. Surg Endosc. 2011 Apr;25(4):1222-9. Epub 2010 Oct 7.
Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1-iT2, iN0): short- and long-term results.
Lezoche G, Guerrieri M, Baldarelli M, Paganini AM, D'Ambrosio G, Campagnacci R, Bartolacci S, Lezoche E.
Source
Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, UniversitÃ Politecnica delle Marche, Via Conca 1, 60121 Ancona, Italy. lez...@me.com
Abstract
BACKGROUND:
Local excision of rectal cancer as an alternative to radical resection for patients with small nonadvanced low rectal cancer (SNALRC) (iT1-iT2, iN0) is debated. This study aimed to analyze the short- and long-term results for a series of 135 patients with SNALRC who underwent local excision by transanal endoscopic microsurgery (TEM).
METHODS:
According to the study protocol, 135 patients classified by endorectal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) imaging as having iT1 iN0 iM0 (n = 51) or iT2 iN0 iM0 (n = 84) low rectal cancer were enrolled in the study. All the patients with iT2 rectal cancer underwent neoadjuvant therapy. The definitive histologic findings showed 24 pT0 patients (17.8%), 66 pT1 patients (48.8%), and 45 pT2 patients (33.4%).
RESULTS:
Minor complications were observed in 12 patients (8.8%) and major complications in 2 patients (1.5%). During a median follow-up period of 97 months (range, 55-139 months), local recurrences occurred for four patients and distant metastases for two patients. The patients who experienced a recurrence had been preoperatively staged as iT2 and were low or nonresponders to neoadjuvant treatment (ypT2). At the end of the follow-up period, the disease-free survival rates were 100% for the iT1 patients and 93% for the iT2 patients
CONCLUSIONS:
The long-term results for adequate local excision by TEM with or without neoadjuvant radiochemotherapy in the treatment of SNALRC based on the current study protocol are not inferior to those reported in the literature for radical surgery with total mesorectal excision (TME).
PMID:

20927544
[PubMed - indexed for MEDLINE]
Related citations

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1.	Arch Surg. 2011 May;146(5):544. Rectal cancer: the good, the bad, and the ugly. Pricolo VE. Source Department of Surgery, Rhode Island Hospitalâ€“Brown University, Providence, Rhode Island 02905, USA. vpri...@usasurg.org Comment on Arch Surg. 2011 May;146(5):540-3.
	PMID: 21739653 [PubMed - indexed for MEDLINE]
	Related citations

2.	Hepatogastroenterology. 2011 Mar-Apr;58(106):364-8. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Wu Y, Wu YY, Li S, Zhu BS, Zhao K, Yang XD, Xing CG. Source Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, China. Abstract BACKGROUND/AIMS: To compare transanal endoscopic microsurgery (TEM) with conventional radical surgery (CRS) for T1 rectal cancer focusing on safety, feasibility and efficacy of both procedures. METHODOLOGY: An online search of Ovid, Medline, Embase, Pubmed and Cochrane Controlled Trials Register was undertaken to identify studies comparing TEM with CRS published in English between 1984 and March 2010. Only studies comparing TEM with CRS for T1 rectal cancer treatment and with a minimum of 20 cases were included. The parameters compared were postoperative complications, hospital mortality, recurrence rate and 5-year survival. RESULTS: Five studies met screening criteria and 397 patients were enrolled in the meta-analysis; 216 were treated with TEM and the rest received CRS. Complications were observed in 16/196 in the TEM group and 77/163 in the CRS group. The difference was significant (p=0.01). The rate of mortality was 3.68% in CRS group, and 0 in TEM group (p=0.01). The 5-year survival was similar (p=0.84), the TEM group was 80.1% and the CRS group was 81.0%. However, there was more recurrence in the TEM group compared to CRS group (p=0.0004). TEM group was 12.0%, while CRS group was 0.5%. CONCLUSION: Compared with CRS, TEM had significant shorter hospital stay and fewer postoperative complications. TEM is a safe, feasible and effective option for T1 rectal cancer. Though TEM had a slightly higher rate of recurrence than CRS, no significant difference on 5-year survival was observed.
	PMID: 21661397 [PubMed - indexed for MEDLINE]
	Related citations

3.	Arch Surg. 2011 May;146(5):540-3. Determining the need for radical surgery in patients with T1 rectal cancer. Salinas HM, Dursun A, Klos CL, Shellito P, Sylla P, Berger D, Bordeianou L. Source Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. Comment in Arch Surg. 2011 May;146(5):544. Abstract HYPOTHESIS: In the era of modern preoperative staging of patients with rectal cancer, lymph node metastases can be reliably predicted by the histological features of the tumor and preoperative imaging. Local resection can then be safely offered to the patients who are at low risk of having malignant lymph nodes. DESIGN: We reviewed the records of 109 consecutive patients with preoperative imaging results suggestive of T1N0 or T2N0 disease who underwent total mesorectal excision. All patients underwent preoperative endorectal ultrasonography or magnetic resonance imaging and computed tomography, with or without positron emission tomography. Final pathologic investigation identified T3 disease in 27 patients. History, physical examination results, and radiologic and pathologic data were evaluated for predictors of positive nodes in the remaining 82 patients. SETTING: Tertiary care referral center. PATIENTS: Patients with preoperative imaging suggestive of T1N0 or T2N0 rectal cancer. MAIN OUTCOME MEASURES: To evaluate different clinical and pathologic tumor features as predictors of positive lymph nodes in T1 and T2 rectal cancers with negative radiographic nodes. BACKGROUND: Local resection of T1 and T2 rectal cancer results in lower morbidity compared with radical resection. However, recurrence rates after local resection are higher, likely owing to unresected nodal metastasis. Reports on predictors of lymph node metastasis remain inconsistent in the literature. Although local resection may be appropriate for some rectal cancers, selection criteria remain unclear. RESULTS: Despite indications of negative nodes on radiographic examination, 4 of 35 patients with T1 disease (11%) and 13 of 47 with T2 disease (28%) had positive nodes. On univariate analysis, the only significant predictor was depth of invasion: 24 of 65 patients with negative nodes (37%) vs 13 of 17 patients with positive nodes (76%) had tumors invading the lower third of the submucosa and beyond (P = .02). On logistic regression analysis accounting for depth of invasion (lower third of the submucosa and beyond), size, distance from anal verge, differentiation, and lymphovascular and small-vessel invasion, only depth of invasion remained a significant predictor. CONCLUSIONS: In all, 89% of patients with T1 disease (31 of 35) and 72% of those with T2 disease (34 of 47) underwent unnecessary radical resection. Endorectal ultrasonography or magnetic resonance imaging and computed tomography, with or without positron emission tomography, for preoperative staging could not identify these patients reliably. In addition, histologic markers of aggressive disease were not helpful. Thus, local resection for T2 rectal cancer is not justified. Local resection should be offered only to patients with superficial T1 tumors who will adhere to aggressive postoperative surveillance.
	PMID: 21576608 [PubMed - indexed for MEDLINE]
	Related citations

4.	Int J Colorectal Dis. 2011 Apr;26(4):437-43. Epub 2011 Jan 27. Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results. Ramirez JM, Aguilella V, Valencia J, Ortego J, Gracia JA, Escudero P, Esco R, Martinez M. Source Department of Colorectal Surgery, University Hospital, Zaragoza, Spain. jram...@unizar.es Abstract PURPOSE: Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention. METHODS: In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment. RESULTS: After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%. CONCLUSIONS: Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.
	PMID: 21271346 [PubMed - indexed for MEDLINE]
	Related citations

5.	Surg Endosc. 2011 Apr;25(4):1222-9. Epub 2010 Oct 7. Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1-iT2, iN0): short- and long-term results. Lezoche G, Guerrieri M, Baldarelli M, Paganini AM, D'Ambrosio G, Campagnacci R, Bartolacci S, Lezoche E. Source Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, UniversitÃ Politecnica delle Marche, Via Conca 1, 60121 Ancona, Italy. lez...@me.com Abstract BACKGROUND: Local excision of rectal cancer as an alternative to radical resection for patients with small nonadvanced low rectal cancer (SNALRC) (iT1-iT2, iN0) is debated. This study aimed to analyze the short- and long-term results for a series of 135 patients with SNALRC who underwent local excision by transanal endoscopic microsurgery (TEM). METHODS: According to the study protocol, 135 patients classified by endorectal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) imaging as having iT1 iN0 iM0 (n = 51) or iT2 iN0 iM0 (n = 84) low rectal cancer were enrolled in the study. All the patients with iT2 rectal cancer underwent neoadjuvant therapy. The definitive histologic findings showed 24 pT0 patients (17.8%), 66 pT1 patients (48.8%), and 45 pT2 patients (33.4%). RESULTS: Minor complications were observed in 12 patients (8.8%) and major complications in 2 patients (1.5%). During a median follow-up period of 97 months (range, 55-139 months), local recurrences occurred for four patients and distant metastases for two patients. The patients who experienced a recurrence had been preoperatively staged as iT2 and were low or nonresponders to neoadjuvant treatment (ypT2). At the end of the follow-up period, the disease-free survival rates were 100% for the iT1 patients and 93% for the iT2 patients CONCLUSIONS: The long-term results for adequate local excision by TEM with or without neoadjuvant radiochemotherapy in the treatment of SNALRC based on the current study protocol are not inferior to those reported in the literature for radical surgery with total mesorectal excision (TME).
	PMID: 20927544 [PubMed - indexed for MEDLINE]
	Related citations