Base de dados : MEDLINE
Pesquisa : E01.370.388.250.630.500.500 [Categoria DeCS]
Referências encontradas : 74 [refinar]
Mostrando: 1 .. 10   no formato [Longo]

página 1 de 8 ir para página                    

  1 / 74 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:29390320
Autor:Xu G; Wang P; Xiao Y; Wu X; Lin G
Endereço:Department of Liver Surgery.
Título:Local resection of rectal neuroendocrine tumor with first clinical manifestation of giant liver metastasis by transanal endoscopic microsurgery: A case report.
Fonte:Medicine (Baltimore); 96(50):e9153, 2017 Dec.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Rectal neuroendocrine tumor (NET) is a relatively rare tumor. Well-differentiated NETs (G1 and G2) rarely display distant metastasis at initial diagnosis. Currently, treatment for the primary lesions of rectal NETs with liver metastasis remains controversial. The liver metastasis was resected in local hospital. Transanal endoscopic microsurgery (TEM) has emerged as an effective minimally invasive surgery for local resection of lower rectal lesions. Herein, we reported the initial application of TEM to remove the rectal primary lesion in patients with low rectal NETs (G2) with giant liver metastases. PATIENT CONCERNS: The patient, a 45-year-old woman, was primarily diagnosed with hepatocellular carcinoma and underwent curative resection of a giant liver lesion in a local hospital. Nevertheless, the postoperative pathologic examination revealed that the lesion was an NET (G2). The colonoscopy then showed a nodule 1.4 cm in diameter, 4 cm above the anal verge, located on the anterior wall of the rectum. The biopsy revealed that the nodule was also an NET (G2). However, the patient did not consent to abdominoperineal resection based on concerns for quality of life. DIAGNOSES: Rectal NET with liver metastasis. INTERVENTIONS: The patient underwent curative resection of liver metastasis. And, TEM was adopted to resect the primary tumor in rectum. OUTCOMES: The patient has been disease-free for 2 years with a good quality of life and presents no local recurrence in the rectum. LESSONS: TEM is an appropriate palliative operation for therapy of rectal NETs with distant metastases, especially for primary rectal NETs located in low rectal.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:29297651
Autor:Shelygin YA; Chernyshov SV; Mainovskaya OA; Zarodnyuk IV; Orlova LP; Rybakov EG
Título:Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment?
Fonte:Vestn Ross Akad Med Nauk; 71(4):3223-31, 2016.
ISSN:0869-6047
País de publicação:Russia (Federation)
Idioma:eng
Resumo:Aim: Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience. Methods: The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI. Results: Three hundred and thirty patients [mean age of 61,4±10 (33­88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6­10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0­14.0). Preoperative biopsy revealed: adenoma ­ 263/330 (79,7%), adenocarcinoma ­ 67/330 (20,3%). The median operating time was 40 (15­220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1­57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence. Conclusion: Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.
Tipo de publicação: JOURNAL ARTICLE


  3 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28796731
Autor:Lee L; Edwards K; Hunter IA; Hartley JE; Atallah SB; Albert MR; Hill J; Monson JR
Endereço:1 Center for Colon and Rectal Surgery, Florida Hospital, Orlando, Florida 2 Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom 3 Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Título:Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally Invasive Surgery: A Multi-institutional Matched Analysis.
Fonte:Dis Colon Rectum; 60(9):928-935, 2017 Sep.
ISSN:1530-0358
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery. OBJECTIVE: The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery. DESIGN: This was a multi-institutional cohort study using coarsened exact matching. SETTINGS: The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons. PATIENTS: Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included. INTERVENTIONS: Transanal endoscopic microsurgery and transanal minimally invasive surgery were the included interventions. MAIN OUTCOME MEASURES: The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured. RESULTS: The matched cohort consisted of 428 patients (247 with transanal endoscopic microsurgery and 181 with transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing transanal endoscopic microsurgery was 80% compared with 78% for patients undergoing transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for transanal endoscopic microsurgery and 7% (7/94) for transanal minimally invasive surgery (p = 0.864). LIMITATIONS: All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods. CONCLUSIONS: High-quality local excision for benign and rectal neoplasms can be equally achieved using transanal endoscopic microsurgery or transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY


  4 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28723770
Autor:Liu Q; Zhong G; Zhou W; Lin G
Endereço:aDepartment of General Surgery bDepartment of Ultrasound cDepartment of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Título:Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy: A case report.
Fonte:Medicine (Baltimore); 96(29):e7538, 2017 Jul.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: The lower rectal gastrointestinal stromal tumor (GIST) is a rare entity and warrants special attentions because of the considerations of preserving of anal and urinal functions. Neoadjuvant therapy with imatinib mesylate (IM) has achieved great success in GIST, which potentially extends the applications of function-preserving minimally invasive surgical procedures. Transanal endoscopic microsurgery (TEM) is a well-developed minimally invasive technique for benign tumors in lower rectum. Herein, we reported the initial application of TEM for high risk GIST after IM treatment. PATIENT CONCERNS: A 52-year-old woman suffered mild lower abdominal pain and perianal discomfort. Physical examination found a soft mass 4 cm far away from anal verge. Rectal MRI and transrectal ultrasound (TRUS) showed that there was a 1.9 × 1.6 cm submucosal mass in the lower rectum. The incisional biopsy was performed and the pathological result reported it was a high-risk GIST. DIAGNOSES: High-risk lower rectal GIST. INTERVENTIONS: IM was given for neoadjuvant therapy. Then TEM was adopted to resect the residual tumor. IM was restored 4 weeks after surgery. OUTCOMES: The final pathological results reported the margin was clear. After an 18-month follow up, no recurrence and metastasis was found and the patient had a satisfactory anal and urinal functions. LESSONS: TEM in combination with IM could be a practical strategy for the high-risk lower rectal GIST simultaneously to achieve curative resection and to preserve the anal and urinal functions that can significantly improve the life quality of the patients.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância:0 (Antineoplastic Agents); 8A1O1M485B (Imatinib Mesylate)


  5 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28602880
Autor:Yano S; Shinojima N; Kawashima J; Kondo T; Hide T
Endereço:Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University Graduate School, Kumamoto, Japan. Electronic address: yanos@kumamoto-u.ac.jp.
Título:Intraoperative Scoring System to Predict Postoperative Remission in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone-Secreting Pituitary Adenomas.
Fonte:World Neurosurg; 105:375-385, 2017 Sep.
ISSN:1878-8769
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To determine the predictive factors for endocrinological remission of patients with growth hormone (GH)-secreting pituitary adenomas. METHODS: In 47 patients with GH-secreting pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery with intraoperative GH measurements from 2002 to 2011, the relationship between the intraoperative GH levels and postoperative remission was analyzed, and 2 items that predicted remission (GH half-life obtained 30 minutes or less after removal and a minimum surgical GH level less than 2.5 ng/mL) were determined. In addition, 2 surgical observations (endoscopic confirmation of no tumor remnants and pathologic confirmation of the absence of tumor remnants in the bordering tissue) were also considered. Positive items resulted in one point, and scores ranged from 0 to 4. For 27 patients who underwent surgery from 2012 onwards, this scoring system was applied by 3 independent operators, and the remission rates and predictive values were estimated. RESULTS: Twenty-six of the 47 (55.3%) patients achieved remission. The remission rates were significantly different for different scores. In the 27 patients treated from 2012 onward, repeat residual tumor examinations were performed if the GH score did not reach 2 at the end of the removal. Nine patients had final scores of 3 or 4. All of these patients achieved remission. In 16 patients with final scores of 2 or less, only 2 with Knosp grades of 0 and 1 achieved remission. CONCLUSIONS: Our scoring system, which incorporated GH measurements and surgical observations, predicted postoperative remission. Complete tumor removal was critical to achieve intraoperative scores over 3.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:9002-72-6 (Growth Hormone)


  6 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28583790
Autor:Rizzo G; Zaccone G; Magnocavallo M; Mattana C; Pafundi DP; Gambacorta MA; Valentini V; Coco C
Endereço:Polo Apparato Digerente e Sistema Endocrino-Metabolico - Area Chirurgica Addominale, Fondazione Policlinico Universitario "Agostino Gemelli" - Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: gianluca.rizzo1979@libero.it.
Título:Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer.
Fonte:Eur J Surg Oncol; 43(8):1488-1493, 2017 Aug.
ISSN:1532-2157
País de publicação:England
Idioma:eng
Resumo:PURPOSE: The aim of this study is to provide a prospective analysis of post-operative and oncological outcomes in patients affected by locally advanced rectal cancer (LARC), who obtained a major/complete clinical response after pre-operative radio-chemotherapy (RCT) and were treated with local excision (LE) by trans-anal endoscopic microsurgery (TEM) to confirm a pathological complete response (pCR) after to neo-adjuvant RCT. METHODS: All patients with LARC treated by pre-operative RCT and full-thickness LE by TEM (2000-2014) were included in the study. If the pathological analysis confirmed near complete or pCR, intensive follow up was proposed. If the pathological response was incomplete, a radical resection with TME was proposed. Post-operative (according to Clavien's classification), functional and long-term oncological outcome were analyzed. RESULTS: 36 patients were treated by TEM. The median post-operative hospital stay was 5 days. The post-operative morbidity was 41.6% (no grade ≥3). At pathological analysis, 23 specimens were ypT0 TRG1, and 4 were ypT1 TRG2. In 9 cases (ypT>1 and/or TRG>2), radical surgery with TME was proposed but 3 refused it. Median follow-up was 68 months. One local recurrence and 4 distant metastases occurred. The 5-yr actuarial local control, overall survival and disease-free survival were 96.0%, 92.0% and 82.8%. CONCLUSIONS: In case of major or complete clinical response of LARC after pre-operative RCT, LE by TEM can be used to confirm the pathological response. This avoids the necessity of radical surgery and, in our experience, this approach seems to guarantee oncological safety with the functional advantages of an organ-sparing procedure.
Tipo de publicação: JOURNAL ARTICLE


  7 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28501248
Autor:Young DO; Kumar AS
Endereço:Colorectal Surgery Program, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, 1100 9th Avenue Seattle, WA 98101, USA.
Título:Local Excision of Rectal Cancer.
Fonte:Surg Clin North Am; 97(3):573-585, 2017 Jun.
ISSN:1558-3171
País de publicação:United States
Idioma:eng
Resumo:Local excision (LE) of early-stage rectal cancer avoids the morbidity associated with radical surgery but has historically been associated with inferior oncologic outcomes. Newer techniques, including transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), have been developed to improve the quality of LE and extend the benefits of LE to tumors in the more proximal rectum. This article provides an overview of conventional LE, TEM, and TAMIS techniques, including indications for their use and pertinent literature on their associated outcomes for rectal cancer.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  8 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28251355
Autor:Junginger T; Goenner U; Hitzler M; Trinh TT; Heintz A; Blettner M; Wollschlaeger D
Endereço:Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. Junginger@uni-mainz.de.
Título:Long-term results of transanal endoscopic microsurgery after endoscopic polypectomy of malignant rectal adenoma.
Fonte:Tech Coloproctol; 21(3):225-232, 2017 Mar.
ISSN:1128-045X
País de publicação:Italy
Idioma:eng
Resumo:BACKGROUND: There is no consensus on the treatment and prognosis of malignant rectal polyps. The aim of the present study was to determine the role of transanal endoscopic microsurgery (TEM) after endoscopic complete polypectomy of malignant rectal adenomas with long-term follow-up. METHODS: Of 105 patients with pT1 rectal carcinoma in 32 patients TEM followed complete endoscopic polypectomy while 73 had primary TEM. Local recurrence (LR), distant metastasis, overall and cancer-specific survival were determined by the Kaplan-Meier method. RESULTS: Median follow-up was 9.1 years. In 32 patients with TEM following complete polypectomy no residual cancer was found. LR occurred in 3/28 (11%) patients with low-risk carcinoma (pT1 G1/2/X, L0/X, R0) and in 1/4 (25%) with high-risk carcinoma (pT1 G3/4 or L1). After primary TEM with complete resection (minimal distance >1 mm) LR occurred in 6/60 (10%) with low-risk carcinoma. After incomplete TEM resection (minimal distance ≤1 mm) LR occurred in 3/8 (38%) patients with low-risk and in 1/5 (20%) patients with high-risk carcinoma. Grading was the only significant risk factor for LR after endoscopic polypectomy followed by TEM (p = 0.002). At all outcomes did not differ between postpolypectomy TEM and primary TEM. CONCLUSIONS: Patients with malignant rectal polyps removed by endoscopic polypectomy have a substantial risk of LR even if TEM of polyp site is cancer free. Risk of LR depends on tumor characteristics. In low-risk carcinoma long-term follow-up is necessary. The high LR rate in patients with high-risk rectal carcinoma restricts the use of TEM alone.
Tipo de publicação: EVALUATION STUDIES; JOURNAL ARTICLE


  9 / 74 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:28059911
Autor:O'Neill CH; Platz J; Moore JS; Callas PW; Cataldo PA
Endereço:1 Department of Surgery, University of Vermont, Burlington, Vermont 2 Department of Biostatistics, University of Vermont, Burlington, Vermont.
Título:Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience.
Fonte:Dis Colon Rectum; 60(2):152-160, 2017 Feb.
ISSN:1530-0358
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: There is debate regarding the appropriate use of transanal endoscopic microsurgery for rectal cancer. OBJECTIVE: This study analyzed our single-center experience with transanal endoscopic microsurgery for early rectal cancer. DESIGN: Medical charts of patients who underwent transanal endoscopic microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded. SETTINGS: The study was conducted at a single academic medical center. PATIENTS: Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included. MAIN OUTCOME MEASURES: Local and overall recurrence and disease-specific survival were measured. RESULTS: A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%-99.8%), and overall survival rate was 89.4% (95% CI, 79.9%-94.6%). LIMITATIONS: The study was limited by its single-center retrospective experience. CONCLUSIONS: Transanal endoscopic microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
Tipo de publicação: JOURNAL ARTICLE


  10 / 74 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
PMID:27888300
Autor:Junginger T; Goenner U; Hitzler M; Trinh TT; Heintz A; Roth W; Blettner M; Wollschlaeger D
Endereço:Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. Junginger@uni-mainz.de.
Título:Analysis of local recurrences after transanal endoscopic microsurgery for low risk rectal carcinoma.
Fonte:Int J Colorectal Dis; 32(2):265-271, 2017 Feb.
ISSN:1432-1262
País de publicação:Germany
Idioma:eng
Resumo:AIM: Rates of local recurrence (LR) after transanal endoscopic microsurgery (TEM) for rectal carcinoma vary; the reasons remain unclear. We analyzed LR after TEM for low-risk pT1 (G1/2/X, L0/X) rectal carcinoma to investigate the influence of completeness of resection and occult lymph node metastasis on risk of LR. METHOD: LR location and stage, completeness of resection of primary carcinoma (minimal distance between tumor and resection line ≤1 mm vs >1 mm), and incidence of involved lymph nodes in resected LR specimens were collected, and tumor characteristics of LR were compared with primary carcinoma. Distant metastasis and overall and cancer-specific survival were determined. RESULTS: LR developed in 14 patients; in 2/4 with R1/X resection, in 3/8 (38%) with clear margins (R0) but a minimal distance of ≤1 mm, and in 9/88 (10%) with formally complete resection. Six of nine patients with formally complete resection underwent radical surgery for LR; in five out of these six, lymph nodes were not involved. In 5/14 patients, LR was poorly differentiated compared to primary carcinoma. Main LR causes were incomplete tumor resection or tumor persistence after formally complete resection. Overall (p = 0.008) and cancer-specific (p < 0.001) survival was lower in LR patients compared to non-LR patients, even if lymph nodes were uninvolved. CONCLUSIONS: The results suggest that most LRs after TEM for low-risk rectal cancer were caused by residual tumor at the previous excision site and not by undetected lymph node metastases. By improved standardization of surgical techniques to ensure complete resection of carcinomas and thorough pathological assessments, most LRs seem to be avoidable.
Tipo de publicação: JOURNAL ARTICLE



página 1 de 8 ir para página                    
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde