Endoscopic posterior mesorectal resection as an option to combine local treatment of early stage rectal cancer with partial mesorectal lymphadenectomy |
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Authors: | Jörg Köninger Beat P Müller-Stich Frank Autschbach Peter Kienle Jürgen Weitz Markus W Büchler Carsten N Gutt |
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Institution: | (1) Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;(2) Department of Pathology, University of Heidelberg, INF 220/221, 69120 Heidelberg, Germany |
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Abstract: | Background and aims Low anterior resection and abdominoperineal resection with total mesorectal excision are the standard treatment in patients
with low rectal cancer. Rectal resection remains a surgical intervention with considerable morbidity and long-term impairment
of quality of life. Local excision of low rectal cancer is regarded as an alternative to radical surgery; however, occurrence
of lymph node metastasis even in patients with highly differentiated early-stage rectal cancer may be underestimated.
Patients and results In two patients with T1 rectal cancer, minimal-invasive partial excision of the mesorectum was performed after transanal excision
of the tumor. The postoperative course was uneventful in both patients. Patients left the hospital on the fourth and fifth
postoperative day without any complaints. In one patient, histo-pathological workup revealed a lymph node metastasis in the
specimen.
Discussion The technique of “Endoscopic posterior mesorectal resection” represents an interesting option in the surgical treatment of
rectal cancer, as it allows for the first time an organ preserving resection of local lymph nodes in the small pelvis. It
may evolve as an efficient new staging procedure to identify patients with metastatic disease who may benefit from multimodal
treatment or extended surgery. |
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Keywords: | Rectal cancer Anterior resection Local excision Post anterior resection syndrome TME |
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