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

2 views

Skip to first unread message

Ricardo Belda Lozano

unread,

Sep 2, 2013, 2:09:32 PM9/2/13

to actualiz...@googlegroups.com

Enviado desde mi iPad

Inicio del mensaje reenviado:

De: My NCBI <efb...@mail.nih.gov>
Fecha: 2 de septiembre de 2013 00:25:41 GMT+02:00
Para: <riki...@hotmail.com>
Asunto: What's new for ' Actualización TEM' in PubMed
Responder a: <riki...@hotmail.com>

This message contains My NCBI what's new results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).
Do not reply directly to this message.
Sender's message: Nueva Bibliografía del TEM
Sent on Sunday, 2013 September 01
Search: "Rectum"[Mesh] OR "Rectal Neoplasms"[Mesh] AND "Microsurgery"[Mesh]

View complete results in PubMed (results may change over time).

Edit saved search settings, or unsubscribe from these e-mail updates.

PubMed Results
Items 1 - 5 of 5

1. Dis Colon Rectum. 2013 Jul;56(7):859-68. doi: 10.1097/DCR.0b013e31828e5a72.
CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer.
Wallin U, Rothenberger D, Lowry A, Luepker R, Mellgren A.
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 52242, USA. ulrik-...@uiowa.edu
Abstract
BACKGROUND:
Preoperative chemoradiation therapy in patients with rectal cancer results in pathologic complete response in approximately 10% to 30% of patients. Accurate predictive factors for obtaining pathologic complete response would likely influence the selection of patients best treated by chemoradiation therapy as the primary treatment without radical surgery.
OBJECTIVE:
The aim of this study was to evaluate the impact of tumor size, stage, location, circumferential extent, patient characteristics, and pretreatment CEA levels on the development of pathologic complete response after chemoradiation therapy.
DESIGN:
This study is a retrospective review.
SETTINGS AND PATIENTS:
Five hundred thirty patients treated with preoperative chemoradiation therapy and radical surgery for rectal adenocarcinoma between 1998 and 2011 were identified. A total of 469 patients remained after excluding patients with a history of pelvic radiation (n = 2), previous transanal endoscopic microsurgery or polypectomy of the primary lesion (n = 15), concurrent malignant tumor (n = 14), and no information about pre- or posttreatment T stage in the chart (n = 30). Preoperative CEA levels were available for 267 patients (57%).
INTERVENTIONS:
Preoperative chemoradiation therapy and total mesorectal excision were performed in patients with rectal cancer.
MAIN OUTCOME:
The primary outcome measured was pathologic complete response.
RESULTS:
: Ninety-six patients (20%) were found to have a pathologic complete response in the operative specimen. Low pretreatment CEA (3.4 vs 9.6 ng/mL; p = 0.008) and smaller mean tumor size (4.2 vs 4.7 cm; p = 0.02) were significantly associated with pathologic complete response. Low CEA levels and interruption in chemoradiation therapy were significant predictors of pathologic complete response in the multivariate analysis. When stratifying for smoking status, low CEA level was significantly associated with pathologic complete response only in the group of nonsmokers (p = 0.02).
LIMITATIONS:
This study was limited by its retrospective design, missing CEA values, and lack of tumor regression grade assessment.
CONCLUSIONS:
We demonstrated an association between low pretreatment CEA levels, interruption in chemoradiation therapy, and pathologic complete response in patients treated with neoadjuvant chemoradiation therapy for locally advanced rectal cancer. The predictive value of CEA in smokers can be limited, and further studies are needed to evaluate the impact of smoking on the predictive value of CEA levels for pathologic complete response in rectal cancer.
PMID: 23739192 [PubMed - indexed for MEDLINE]
Related citations

2. J Laparoendosc Adv Surg Tech A. 2013 Mar;23(3):216-9. doi: 10.1089/lap.2012.0394.
Repeated transanal endoscopic microsurgery is feasible and safe.
Khoury W, Gilshtein H, Nordkin D, Kluger Y, Duek SD.
Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
Abstract
BACKGROUND:
The benefits of transanal endoscopic microsurgery (TEM) for the excision of benign and low-grade malignant lesions in the low and middle rectum are well recognized. This study examined the feasibility and safety of a repeated TEM procedure.
PATIENTS AND METHODS:
Patients who underwent a repeat TEM for excision of rectal lesions, either for involved resection margins or for local recurrence, between the years 2000 and 2010, were identified. Rectal lesion characteristics were retrieved. Mean operative times, length of hospital stay, and intra- and postoperative complications were compared between primary and repeated procedures. The postoperative histopathology reports were reviewed, and the adequacy of resection was determined. All patients completed a questionnaire based on the Wexner score for anal sphincter function evaluation.
RESULTS:
Fourteen patients (3 female, 11 male) underwent a repeat TEM operation during the study period. All procedures were completed endoscopically. Indications for repeated TEM were involved margins in 12 patients and recurrence of benign tumor in 2. Mean operative time, mean length of hospital stay, and rate of postoperative complications were similar for primary and repeated TEM procedures (62.5 ± 17 versus 55 ± 23 minutes, P=.181; 1.7 ± 1.3 versus 1.7 ± 1.12 days, P=.99; and 35.7% versus 21.4%, P=.66, respectively). The Wexner score was comparable at baseline and after the first and the second TEM procedures (1.5 ± 2.3, 1.5 ± 2.3, and 3.3 ± 3.1, respectively; P=.188). No cases of fecal incontinence following a repeat TEM were documented.
CONCLUSIONS:
Repeated TEM is feasible and safe and may be appropriate for selected patients.
PMID: 23464870 [PubMed - indexed for MEDLINE]
Related citations

3. Tech Coloproctol. 2013 Feb;17 Suppl 1:S55-61. doi: 10.1007/s10151-012-0936-0. Epub 2013 Jan 12.
Transanal endoscopic microsurgery.
Morino M, Arezzo A, Allaix ME.
Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences, University of Turin, corso Dogliotti 14, 10126 Turin, Italy. mario....@unito.it
Abstract
The aim of oncologic surgery is radical cancer treatment with preservation of function and quality of life. Almost 30 years ago, transanal endoscopic microsurgery (TEM) revolutionised the technique and outcomes of transanal surgery, first becoming the standard of treatment for large rectal adenomas, then offering a possibly curative treatment for early rectal cancer, and finally generating discussion on its potential role in combination with neoadjuvant therapies for the treatment of more invasive cancer. TEM afforded the advantage of combining a less invasive transanal approach with low recurrence rates thanks to enhanced visualization of the surgical field, which allows more precise dissection. We describe the current indications, the preoperative work-up, the surgical technique (with the aid of a video), postoperative management and results obtained in an over 20-year-long experience. Designed as an accurate means to allow excision of benign rectal neoplasms with a very low morbidity rate, TEM today is indicated as a curative treatment of malignant neoplasms that are histologically confirmed as pT1 sm1 carcinomas. T1 sm2-3 and T2 lesions should at present be included in prospective trials. Accurate preoperative staging is essential for optimal selection of patients. Patients with clear indication for TEM should be referred to specialized medical centres experienced with the technique.
PMID: 23314951 [PubMed - indexed for MEDLINE]
Related citations

4. Surg Endosc. 2013 Feb;27(2):518-24. doi: 10.1007/s00464-012-2471-5. Epub 2012 Jul 18.
Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China.
Han Y, He YG, Zhang HB, Lv KZ, Zhang YJ, Lin MB, Yin L.
Department of General Surgery, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, No.197, Ruijin No 2 road, Shanghai, China. myst...@hotmail.com
Abstract
BACKGROUND:
This study was designed to evaluate the feasibility and safety of total laparoscopic sigmoid and rectal surgery without abdominal incision in combination with transanal endoscopic microsurgery (TEM).
METHODS:
From May 2010 to October 2011, 34 patients with colon and rectal tumors were treated by total laparoscopic surgery without abdominal incision, and the clinical data of these patients were reviewed.
RESULTS:
All operations could be successfully accomplished without conversion to open surgery. No diverting ileostomy was created. The average operative time was 151.60 (range, 125-185) minutes. The average blood loss was 200.20 (range, 55-450) ml. All resection margins were negative. Six patients developed postoperative anastomotic leakage. There were no reports of other complications in all patients.
CONCLUSIONS:
This preliminary study indicated that total laparoscopic sigmoid and rectal surgery in combination with TEM was a safe, feasible, and minimally invasive technique. This advanced surgical technique was developed by combining laparoscopy with the concept of natural orifice transluminal endoscopic surgery.
PMID: 22806529 [PubMed - indexed for MEDLINE]
Related citations

5. Surg Today. 2013 Mar;43(3):325-8. doi: 10.1007/s00595-012-0227-4. Epub 2012 Jun 16.
Single-incision laparoscopic surgery used to perform transanal endoscopic microsurgery (SILSTEM) for T1 rectal cancer under spinal anesthesia: report of a case.
Hayashi S, Takayama T, Yamagata M, Matsuda M, Masuda H.
Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchikamimachi, Itabashi, Tokyo, 173-8610, Japan. hayashi....@nihon-u.ac.jp
Abstract
Transanal endoscopic surgery has slowly gained widespread acceptance among colorectal surgeons, despite the need for specific training and the high costs of specialized instrumentation. At the other extreme, some laparoscopic surgeons recommend single port access surgery using a single-incision laparoscopic surgery port. Single-incision laparoscopic surgery was applied to perform transanal endoscopic microsurgery in a patient with T1 rectal cancer under spinal anesthesia. The patient was a 74-year-old man who presented with a 2-cm elevated lesion in the right anterior portion of the rectum. Ordinary laparoscopic instruments were used to perform submucosal resection. The tumor was completely excised from the rectal wall with the use of an ultrasonic surgical scissors. The patient recovered uneventfully and was discharged 4 days after the operation. There was no fecal incontinence or soiling during the postoperative follow-up. Colonoscopy at 4 months after the operation showed no recurrence of either adenocarcinoma or adenoma.
PMID: 22706723 [PubMed - indexed for MEDLINE]
Related citations

Reply all

Reply to author

Forward

0 new messages

1.	Dis Colon Rectum. 2013 Jul;56(7):859-68. doi: 10.1097/DCR.0b013e31828e5a72. CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer. Wallin U, Rothenberger D, Lowry A, Luepker R, Mellgren A. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 52242, USA. ulrik-...@uiowa.edu Abstract BACKGROUND: Preoperative chemoradiation therapy in patients with rectal cancer results in pathologic complete response in approximately 10% to 30% of patients. Accurate predictive factors for obtaining pathologic complete response would likely influence the selection of patients best treated by chemoradiation therapy as the primary treatment without radical surgery. OBJECTIVE: The aim of this study was to evaluate the impact of tumor size, stage, location, circumferential extent, patient characteristics, and pretreatment CEA levels on the development of pathologic complete response after chemoradiation therapy. DESIGN: This study is a retrospective review. SETTINGS AND PATIENTS: Five hundred thirty patients treated with preoperative chemoradiation therapy and radical surgery for rectal adenocarcinoma between 1998 and 2011 were identified. A total of 469 patients remained after excluding patients with a history of pelvic radiation (n = 2), previous transanal endoscopic microsurgery or polypectomy of the primary lesion (n = 15), concurrent malignant tumor (n = 14), and no information about pre- or posttreatment T stage in the chart (n = 30). Preoperative CEA levels were available for 267 patients (57%). INTERVENTIONS: Preoperative chemoradiation therapy and total mesorectal excision were performed in patients with rectal cancer. MAIN OUTCOME: The primary outcome measured was pathologic complete response. RESULTS: : Ninety-six patients (20%) were found to have a pathologic complete response in the operative specimen. Low pretreatment CEA (3.4 vs 9.6 ng/mL; p = 0.008) and smaller mean tumor size (4.2 vs 4.7 cm; p = 0.02) were significantly associated with pathologic complete response. Low CEA levels and interruption in chemoradiation therapy were significant predictors of pathologic complete response in the multivariate analysis. When stratifying for smoking status, low CEA level was significantly associated with pathologic complete response only in the group of nonsmokers (p = 0.02). LIMITATIONS: This study was limited by its retrospective design, missing CEA values, and lack of tumor regression grade assessment. CONCLUSIONS: We demonstrated an association between low pretreatment CEA levels, interruption in chemoradiation therapy, and pathologic complete response in patients treated with neoadjuvant chemoradiation therapy for locally advanced rectal cancer. The predictive value of CEA in smokers can be limited, and further studies are needed to evaluate the impact of smoking on the predictive value of CEA levels for pathologic complete response in rectal cancer.
	PMID: 23739192 [PubMed - indexed for MEDLINE]
	Related citations

2.	J Laparoendosc Adv Surg Tech A. 2013 Mar;23(3):216-9. doi: 10.1089/lap.2012.0394. Repeated transanal endoscopic microsurgery is feasible and safe. Khoury W, Gilshtein H, Nordkin D, Kluger Y, Duek SD. Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. Abstract BACKGROUND: The benefits of transanal endoscopic microsurgery (TEM) for the excision of benign and low-grade malignant lesions in the low and middle rectum are well recognized. This study examined the feasibility and safety of a repeated TEM procedure. PATIENTS AND METHODS: Patients who underwent a repeat TEM for excision of rectal lesions, either for involved resection margins or for local recurrence, between the years 2000 and 2010, were identified. Rectal lesion characteristics were retrieved. Mean operative times, length of hospital stay, and intra- and postoperative complications were compared between primary and repeated procedures. The postoperative histopathology reports were reviewed, and the adequacy of resection was determined. All patients completed a questionnaire based on the Wexner score for anal sphincter function evaluation. RESULTS: Fourteen patients (3 female, 11 male) underwent a repeat TEM operation during the study period. All procedures were completed endoscopically. Indications for repeated TEM were involved margins in 12 patients and recurrence of benign tumor in 2. Mean operative time, mean length of hospital stay, and rate of postoperative complications were similar for primary and repeated TEM procedures (62.5 ± 17 versus 55 ± 23 minutes, P=.181; 1.7 ± 1.3 versus 1.7 ± 1.12 days, P=.99; and 35.7% versus 21.4%, P=.66, respectively). The Wexner score was comparable at baseline and after the first and the second TEM procedures (1.5 ± 2.3, 1.5 ± 2.3, and 3.3 ± 3.1, respectively; P=.188). No cases of fecal incontinence following a repeat TEM were documented. CONCLUSIONS: Repeated TEM is feasible and safe and may be appropriate for selected patients.
	PMID: 23464870 [PubMed - indexed for MEDLINE]
	Related citations

3.	Tech Coloproctol. 2013 Feb;17 Suppl 1:S55-61. doi: 10.1007/s10151-012-0936-0. Epub 2013 Jan 12. Transanal endoscopic microsurgery. Morino M, Arezzo A, Allaix ME. Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences, University of Turin, corso Dogliotti 14, 10126 Turin, Italy. mario....@unito.it Abstract The aim of oncologic surgery is radical cancer treatment with preservation of function and quality of life. Almost 30 years ago, transanal endoscopic microsurgery (TEM) revolutionised the technique and outcomes of transanal surgery, first becoming the standard of treatment for large rectal adenomas, then offering a possibly curative treatment for early rectal cancer, and finally generating discussion on its potential role in combination with neoadjuvant therapies for the treatment of more invasive cancer. TEM afforded the advantage of combining a less invasive transanal approach with low recurrence rates thanks to enhanced visualization of the surgical field, which allows more precise dissection. We describe the current indications, the preoperative work-up, the surgical technique (with the aid of a video), postoperative management and results obtained in an over 20-year-long experience. Designed as an accurate means to allow excision of benign rectal neoplasms with a very low morbidity rate, TEM today is indicated as a curative treatment of malignant neoplasms that are histologically confirmed as pT1 sm1 carcinomas. T1 sm2-3 and T2 lesions should at present be included in prospective trials. Accurate preoperative staging is essential for optimal selection of patients. Patients with clear indication for TEM should be referred to specialized medical centres experienced with the technique.
	PMID: 23314951 [PubMed - indexed for MEDLINE]
	Related citations

4.	Surg Endosc. 2013 Feb;27(2):518-24. doi: 10.1007/s00464-012-2471-5. Epub 2012 Jul 18. Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China. Han Y, He YG, Zhang HB, Lv KZ, Zhang YJ, Lin MB, Yin L. Department of General Surgery, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, No.197, Ruijin No 2 road, Shanghai, China. myst...@hotmail.com Abstract BACKGROUND: This study was designed to evaluate the feasibility and safety of total laparoscopic sigmoid and rectal surgery without abdominal incision in combination with transanal endoscopic microsurgery (TEM). METHODS: From May 2010 to October 2011, 34 patients with colon and rectal tumors were treated by total laparoscopic surgery without abdominal incision, and the clinical data of these patients were reviewed. RESULTS: All operations could be successfully accomplished without conversion to open surgery. No diverting ileostomy was created. The average operative time was 151.60 (range, 125-185) minutes. The average blood loss was 200.20 (range, 55-450) ml. All resection margins were negative. Six patients developed postoperative anastomotic leakage. There were no reports of other complications in all patients. CONCLUSIONS: This preliminary study indicated that total laparoscopic sigmoid and rectal surgery in combination with TEM was a safe, feasible, and minimally invasive technique. This advanced surgical technique was developed by combining laparoscopy with the concept of natural orifice transluminal endoscopic surgery.
	PMID: 22806529 [PubMed - indexed for MEDLINE]
	Related citations

5.	Surg Today. 2013 Mar;43(3):325-8. doi: 10.1007/s00595-012-0227-4. Epub 2012 Jun 16. Single-incision laparoscopic surgery used to perform transanal endoscopic microsurgery (SILSTEM) for T1 rectal cancer under spinal anesthesia: report of a case. Hayashi S, Takayama T, Yamagata M, Matsuda M, Masuda H. Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ooyaguchikamimachi, Itabashi, Tokyo, 173-8610, Japan. hayashi....@nihon-u.ac.jp Abstract Transanal endoscopic surgery has slowly gained widespread acceptance among colorectal surgeons, despite the need for specific training and the high costs of specialized instrumentation. At the other extreme, some laparoscopic surgeons recommend single port access surgery using a single-incision laparoscopic surgery port. Single-incision laparoscopic surgery was applied to perform transanal endoscopic microsurgery in a patient with T1 rectal cancer under spinal anesthesia. The patient was a 74-year-old man who presented with a 2-cm elevated lesion in the right anterior portion of the rectum. Ordinary laparoscopic instruments were used to perform submucosal resection. The tumor was completely excised from the rectal wall with the use of an ultrasonic surgical scissors. The patient recovered uneventfully and was discharged 4 days after the operation. There was no fecal incontinence or soiling during the postoperative follow-up. Colonoscopy at 4 months after the operation showed no recurrence of either adenocarcinoma or adenoma.
	PMID: 22706723 [PubMed - indexed for MEDLINE]
	Related citations