Transanal microscopic surgery in the treatment of recurrent rectal cancer in the elderly

http://www.sciencedirect.com/science/article/pii/S0748798312009377# ------ Background: Transanal microscopic surgery is an important application of minimally invasive surgery of the rectum, allowing complex intervention by transanal excision of full-thickness resection with anastomotic reconstruction. Transanal endoscopic microsurgery (TEM) can have a diagnostic and therapeutic value in the treatment of relapse in the elderly. Methods: Between January 2002 and December 2010, 7 patients (5 men and 2 women; mean age, 66 years) with early rectal cancer recurrence were selected for this palliative surgical procedure for recurrent tumor from adenocarcinoma of the rectum. Four men and 1 woman had undergone ultra-low anterior resection, followed by chemo- or radiotherapy (T3N1M0); one woman had received TEM (T1NxM0) and one man underwent local excision after neoadiuvant chemo/radio therapy (T2NxM0). The patients were selected according to rigid sigmoidoscope, echo transrectal colonoscopy and abdominal echo ultrasound to rule out liver metastases, computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis, with and without contrast material, and positron- emission tromography-CT. The lesions were superficial (<2 cm) and localized to the posterior wall of the rectum. Results: Follow-up was approximately 12-28 months; histopathologic staging confirmed the complete excision of recurrences. The patients were then referred for complementary therapies. Only 1 patient presented with retrorectal abscess, which was treated with conservative techniques. Conclusion: The significance of local recurrence for conservative treatment of adenocarcinoma of the rectum is still controversial because the recurrence is an expression of tumor spread uncontrolled by surgical and radio- or chemotherapy. The alternative to conservative surgery is an abdominoperineal resection according to Miles, but this highly invasive procedure can be considered palliative in the majority of recurrences. Based on equal cancer treatment, the reduction of surgical trauma and preservation of anatomical integrity are an important result.