References

gnck

Колопроктология

Koloproktologia

2073-75562686-7303

Russian Association of Coloproctology

10.33878/2073-7556-2019-18-3-20-40

gnck-1500

Research Article

СТАТЬЯ НОМЕРА

LEADING ARTICLE

РЕЗУЛЬТАТЫ 600 ТРАНСАНАЛЬНЫХ ЭНДОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПО ПОВОДУ АДЕНОМ И АДЕНОКАРЦИНОМ ПРЯМОЙ КИШКИ

THE RESULTS OF 600 TRANSANAL ENDOSCOPIC SURGERIES OF RECTAL ADENOMAS AND ADENOCARCINOMAS

Хомяков

Е. А.

Khomyakov

E. A.

Чернышов

С. В.

Chernyshov

S. V.

stchernyshov@gmail.com

Рыбаков

Е. Г.

Rybakov

E. G.

Майновская

О. А.

Maynovskaya

O. A.

Шелыгин

Ю. А.

Shelygin

Yu. A.

ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава РоссииРоссияState Scientific Centre of Coloproctology of the Ministry of Healthcare of RussiaRussian Federation

2019

23082019

183(69)2040

2019

Хомяков Е.А., Чернышов С.В., Рыбаков Е.Г., Майновская О.А., Шелыгин Ю.А.

Khomyakov E.A., Chernyshov S.V., Rybakov E.G., Maynovskaya O.A., Shelygin Y.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.ruproctology.com/jour/article/view/1500

ЦЕЛЬ. Трансанальная эндомикрохирургия (ТЕМ) – метод выбора для локального иссечения опухолей прямой кишки. Представленная серия больных собрана проспективно и является самой большой из опубликованных в российской медицинской периодике. ПАЦИЕНТЫ И МЕТОДЫ. 600 пациентов (средний возраст ±σ 59,8±9 (31-90) лет; 375/600 (62,5%) – женщины), с аденомами и аденокарциномами прямой кишки, которые оперированы в объеме ТЕМ в 2011-2019 гг. РЕЗУЛЬТАТЫ. Средний размер удаленных опухолей составил 3,4±1,5 см (0,5-10,0). R0 резекции были выполнены в 571/600 (95,2%) случаев. Частота осложнений составила 3,6% (22/600). При патоморфологическом исследовании удаленных препаратов аденома выявлена у 450/600 (75,0%) больных, аденокарцинома – в 150/600 (25,0%) случаях. Среднее время наблюдения больных с аденомами составило 38,4±25,1 мес., с аденокарциномами – 33,4±23,8 месяцев. Частота местных рецидивов при аденомах составила 4,5%. Локорегионарный рецидив аденокарциномы рТ1 после ТЕМ выявлен у 6,8% больных и у 30% больных рТ2 без адъювантного лечения. ЗАКЛЮЧЕНИЕ. ТЕМ эффективный и безопасный метод лечения аденом прямой кишки. При раке прямой кишки необходим тщательный отбор пациентов.

AIM: transanal endomicrosurgery (TEM) is the method of choice for local excision of rectal cancer. The presented series of patients is collected prospectively and is the largest of the published in the Russian medical periodicals. PATIENTS AND METHODS: six-hundred patients [average age ±σ 59.8±9 (31-90) years old; 375/600 (62.5%) – women]with rectal adenomas and adenocarcinomas, who underwent TEM in 2011-2019. RESULTS: the mean size of the removed tumors was 3.4±1.5 cm (0.5-10.0). R0 resection was performed in 571/600 (95.2%) of the cases. The complication rate was 3.6% (22/600). Pathomorphological study of the removed specimens revealed adenoma in 450/600 (75.0%) patients, adenocarcinoma in 150/600 (25.0%) cases. The mean time of observation of patients with adenomas was 38.4±25.1 months, with adenocarcinomas – 33.4±23.8 months. The rate of local recurrence in adenomas was 4.5%. Loco-regional recurrence of adenocarcinoma pT1 after TEM was revealed in 6.8% of patients and 30% of pT2 patients without adjuvant treatment. CONCLUSION: TEM is an effective and safe method of treatment of rectal adenomas. With rectal cancer, a thorough selection of patients is required.

трансанальная эндомикрохирургияаденомааденокарциномапрямая кишка

transanal endomicrosurgeryadenomaadenocarcinomarectum

References1

Allaix ME, Arezzo A, Cassoni P et al. Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc. 2012; 26(9):2594-600. doi: 10.1007/s00464-012-2238-z.

Saclarides TJ. TEM/local excision: indications, techniques, outcomes, and the future. J Surg Oncol. 2007; 96:644-50. doi. org/10.1002/jso.20922

Sajid MS, Farag S, Leung P et al. Systematic review and meta-analysis of published trials comparing the effectiveness of transanal endoscopic microsurgery and radical resection in the management of early rectal cancer. Colorectal Dis. 2014;16(1):2-14. doi: 10.1111/ codi.12474.

Sajid MS, Farag S, Leung P et al. Systematic review and meta-analysis of published trials comparing the effectiveness of trans-anal endoscopic microsurgery and radical resection in the management of early rectal cancer. Colorectal Dis. 2014;16(1):2-14. doi: 10.1111/codi.12474.

Barendse RM, van den Broek FJ, Dekker E et al. Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy. 2011; 43(11):941-9. doi: 10.1055/s-0030-1256765.

Шелыгин Ю.А., Чернышов С.В., Майновская О.А. и соавт. Может ли трансанальная эндомикрохирургия являться основным методом лечения раннего рака прямой кишки. Вестник Российской академии медицинских наук. 2016; № 71(4), с. 323-331.

Shelygin Yu.A., Chernyshov S.V., Majnovskaya O.A. et al. Early rectal cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standart Treatment? Annals of Russian Academy of Medical Sciences. 2016; № 71(4), pp. 323-331. (in Russ.)

Шелыгин Ю.А., Чернышов С.В., Пересада И.В. Первый опыт трансанальных эндоскопических операций. Колопроктология. 2012; № 2(40), с. 34-40.

Shelygin Yu.A., Chernyshov S.V., Peresada I.V. First experience of transanal endoscopic operations. Koloproktologia. 2012; № 2(40), pp. 34-40. (in Russ.)

Bach SP, Hill J, Monson JRT et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg. 2009; 96:280-290. doi: 10.1002/bjs.6456.

Kikuchi R, Takano M, Takagi K et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995; № 38:1286-1295.

Eid Y, Alves A, Lubrano J, Menahem B. Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature. J Visc Surg. 2018; 155(6):445-452. doi: 10.1016/j.jviscsurg.2018.03.008.

Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic sugery of the rectum-testing a new method in animal experiments. Leber Magen Darm. 1983;13(2):73-7.

Mege D, Bridoux V, Maggiori L, Tuech JJ, et al. What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and a disposable material. Int J Colorectal Dis. 2017;32(7):1041-1045.

Ramkumar J, Letarte F, Karimuddin AA, et al. Assessing the safety and outcomes of repeat transanal endoscopic microsurgery. Surg Endosc. 2019 doi: 10.1007/s00464-018-6501-9.

Serra-Aracil X., Labró-Ciurans M., Rebasa P. et al. Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program. Surg Endosc. 2018. doi: 10.1007/s00464-018-6432-5.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in cohort of 6336 patients and results of a survey. Ann Surg. 2004; № 240(2):205-213. DOI: 10.1097/01.sla.0000133083.54934.ae

Карпухин А.В., Поспехова Н.И., Музаффарова Т.А. и соавт. Молекулярная диагностика моногенных форм рака. Медицинская генетика. 2006; № 5, с. 2-7.

Karpuhin A.V., Pospekhova N.I., Muzaffarova T.A. et al. Molecular diagnosis of monogenic cancer. Medical genetics. 2006; № 5, pp. 2-7. (in Russ.)

Ramirez JM, Elia M, Cordoba E. et al. Current controversies in transanal surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech. 2016; 26:431–438. DOI: 10.1097/SLE.0000000000000357

Rectal cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2019. doi: 10.6004/jnccn.2018.0061.

Glynne-Jones R et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017; 28 (Supplement 4): 22-40. doi: 10.1093/annonc/mdx224.

Glynne-Jones R et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017; 28 (Supplement 4): 22-40. doi: 10.1093/annonc/ mdx224.

Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2015 году (Заболеваемость и смертность). Москва, 2017.

Kaprin A.D., Starinskij V.V., Petrova G.V. Malignant neoplasms in Russia in 2015 (morbidity and mortality). Moskow, 2017. (in Russ.)

Jackman RJ, Mayo CW. The adenoma-carcinoma sequence in cancer of the colon. Surg Gynecol Obstet. 1951; 93:327-330.

Scala A, Gravante G, Datsur N et al. Transanal endoscopic microsurgery in small, large, and giant rectal adenomas. Arch Surg. 2012; 147(12):1093-100. doi: 10.1001/archsurg.2012.1954

Vukanic D, Waters PS, O’Riordan J, Neary P et al. Factors Associated With Margin Positivity and Incidental Carcinoma in Patients Undergoing Transanal Endoscopic Microsurgery (TEMS) for the Management of Adenomatous and Dysplastic Rectal Lesions. Surg Laparosc Endosc Percutan Tech. 2019 Apr;29(2):95-100. doi: 10.1097/ SLE.0000000000000618.

Leijtens JWA, Koedam TWA, Borstlap WAA, et al. Transanal Endoscopic Microsurgery with or without Completion Total Mesorectal Excision for T2 and T3 Rectal Carcinoma. Dig Surg. 2019;36(1):76-82.

Levic K, Bulut O, Hesselfeldt P, Bülow S. The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study. Tech Coloproctol. 2013 Aug;17(4):397-403. doi: 10.1007/s10151-012-0950-2.

Guerrieri M, Gesuita R, Ghiselli R et al. Treatment of rectal cancer by transanal endoscopic microsurgery: Experience with 425 patients. World J Gastroenterol. 2014; № 28: 9556-63. doi: 10.3748/wjg.v20. i28.9556

Morino M, Allaix ME, Caldart M, Scozzari G, et al. Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm. Surg Endosc. 2011; 25(11):3683-90. doi: 10.1007/s00464-011-1777-z.

The authors declare that there are no conflicts of interest present.