Bibliografía TEM

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Oct 1, 2011, 4:26:26 PM10/1/11

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Actualización !

Ricardo Belda Lozano

MD,PhD, MS.

Master en Cirugía Laparoscópica

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Sender's message: Nueva Bibliografía del TEM
Sent on Saturday, 2011 Oct 01
Search "Rectum"[Mesh] OR "Rectal Neoplasms"[Mesh] AND "Microsurgery"[Mesh]
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1. Am Surg. 2011 Jun;77(6):761-72.
Transanal endoscopic microsurgery for T1 and T2 rectal cancers: a meta-analysis and meta-regression analysis of outcomes.
Sgourakis G, Lanitis S, Gockel I, Kontovounisios C, Karaliotas C, Tsiftsi K, Tsiamis A, Karaliotas CC.
Source
Second Surgical Department and Surgical Oncology Unit of Korgialenio - Benakio, Red Cross Hospital, Athens, Greece. ggsgo...@yahoo.gr
Abstract
The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective comparative studies were evaluated. End-points included perioperative outcomes, margin involvement, disease-free and overall survival, and recurrence. The number of patients with major (odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.91) and overall postoperative complications (OR = 0.16, 95% CI 0.06-0.38) were significantly lower in TEM. The disease-free survival was higher in standard resection (SR) group compared with TEM (OR = 0.46, 95% CI 0.24-0.88). The number of patients with positive margins were less in the SR group (OR = 6.49, 95% CI 1.49-24.91), which was associated with lower local recurrence (OR = 4.92, 95% CI 1.81-13.41) and overall recurrence rate (OR = 2.03, 95% CI 1.15-3.57). No survival advantage was observed in favor of either procedure. TEM had lower rate of positive margins and longer disease-free survival when compared with transanal excision (TAE). TEM seems to be superior to SR concerning morbidity whilst less effective in obtaining negative surgical margins, and it is associated with higher local and overall recurrence. No survival advantage was observed in favor of either procedure. Unfavorable tumor preoperative histology does not seem to influence the selection between TEM and SR. TEM is more effective than TAE in obtaining negative surgical margins and shows a greater disease-free survival.
PMID:

21679648
[PubMed - indexed for MEDLINE]
Related citations

2. Semin Radiat Oncol. 2011 Jul;21(3):178-84.
Local excision : is it an adequate substitute for radical resection in T1/T2 patients?
You YN.
Source
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. yn...@mdanderson.org
Abstract
Local excision (LE) was historically developed to palliate patients with rectal adenocarcinoma who either are medically unfit or have adamantly refused to undergo transabdominal standard resection (SR) procedures. Over the years, the tradeoffs between the oncologic benefit and adverse functional sequelae associated with SR procedures have been increasingly recognized. In parallel, there has been growing interest in considering LE as an alternative to SR in select patients with early-stage disease. However, concerns regarding its oncologic adequacy remain. These concerns relate to the adequacy of tumor resection, the removal of mesorectal disease, the accuracy of preoperative selection, and the use of adjunctive treatment modalities. Evolving strategies that aim at improving the oncologic outcomes of LE for stage I T1/T2 rectal cancers include adoption of transanal endoscopic microsurgery and the addition of non-surgical modalities. Current evidence surrounding these approaches is examined to provide a basis for an informed discussion with patients. Key factors to be considered in formulating the treatment plan for an individual patient with T1/T2 rectal cancer are summarized.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID:

21645862
[PubMed - indexed for MEDLINE]
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1.	Am Surg. 2011 Jun;77(6):761-72. Transanal endoscopic microsurgery for T1 and T2 rectal cancers: a meta-analysis and meta-regression analysis of outcomes. Sgourakis G, Lanitis S, Gockel I, Kontovounisios C, Karaliotas C, Tsiftsi K, Tsiamis A, Karaliotas CC. Source Second Surgical Department and Surgical Oncology Unit of Korgialenio - Benakio, Red Cross Hospital, Athens, Greece. ggsgo...@yahoo.gr Abstract The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective comparative studies were evaluated. End-points included perioperative outcomes, margin involvement, disease-free and overall survival, and recurrence. The number of patients with major (odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.91) and overall postoperative complications (OR = 0.16, 95% CI 0.06-0.38) were significantly lower in TEM. The disease-free survival was higher in standard resection (SR) group compared with TEM (OR = 0.46, 95% CI 0.24-0.88). The number of patients with positive margins were less in the SR group (OR = 6.49, 95% CI 1.49-24.91), which was associated with lower local recurrence (OR = 4.92, 95% CI 1.81-13.41) and overall recurrence rate (OR = 2.03, 95% CI 1.15-3.57). No survival advantage was observed in favor of either procedure. TEM had lower rate of positive margins and longer disease-free survival when compared with transanal excision (TAE). TEM seems to be superior to SR concerning morbidity whilst less effective in obtaining negative surgical margins, and it is associated with higher local and overall recurrence. No survival advantage was observed in favor of either procedure. Unfavorable tumor preoperative histology does not seem to influence the selection between TEM and SR. TEM is more effective than TAE in obtaining negative surgical margins and shows a greater disease-free survival.
	PMID: 21679648 [PubMed - indexed for MEDLINE]
	Related citations

2.	Semin Radiat Oncol. 2011 Jul;21(3):178-84. Local excision : is it an adequate substitute for radical resection in T1/T2 patients? You YN. Source Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. yn...@mdanderson.org Abstract Local excision (LE) was historically developed to palliate patients with rectal adenocarcinoma who either are medically unfit or have adamantly refused to undergo transabdominal standard resection (SR) procedures. Over the years, the tradeoffs between the oncologic benefit and adverse functional sequelae associated with SR procedures have been increasingly recognized. In parallel, there has been growing interest in considering LE as an alternative to SR in select patients with early-stage disease. However, concerns regarding its oncologic adequacy remain. These concerns relate to the adequacy of tumor resection, the removal of mesorectal disease, the accuracy of preoperative selection, and the use of adjunctive treatment modalities. Evolving strategies that aim at improving the oncologic outcomes of LE for stage I T1/T2 rectal cancers include adoption of transanal endoscopic microsurgery and the addition of non-surgical modalities. Current evidence surrounding these approaches is examined to provide a basis for an informed discussion with patients. Key factors to be considered in formulating the treatment plan for an individual patient with T1/T2 rectal cancer are summarized. Copyright © 2011 Elsevier Inc. All rights reserved.
	PMID: 21645862 [PubMed - indexed for MEDLINE]
	Related citations