Skip to main content
SpringerLink
Log in

Local therapy of rectal tumors

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of the study is to outline the rising importance of local treatment of rectal tumors and a changing strategy in therapy of early rectal cancer. METHODS: As the surgical procedure, transanal endoscopic microsurgery was used. Indications for the local procedure were pT1 low-risk tumors and tumors of higher stages in patients with severe risk factors and of those who refused the operation according to oncologic guidelines. RESULTS: A total of 236 rectal adenomas and 98 carcinomas were locally excised using the transanal endoscopic microsurgery technique. Mortality rate was 0.3 percent, and rate of complications requiring surgical reintervention was 5.5 percent in adenomas and 8 percent in carcinomas. Final histology of removed carcinomas revealed 56 pT1, 27 pT2, and 15 pT3 stages. After an average follow-up time of 24 months, two recurrences were observed in the group of patients with pT1 low-risk carcinomas who only underwent local therapy. In both cases, a second intervention for cure was undertaken but for tumors in a late stage. CONCLUSIONS: In selected cases, local therapy of rectal carcinoma avoids high morbidity and mortality of the classical operation. Quality of life will be improved, especially if an artificial anus can be avoided. In case of recurrence, the chance of a secondary procedure for cure is not to be underestimated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kraske P. Zur exstirpation hochsitzender mastdarmkrebse. Verh Dtsch Ges Chir 1885;14:464–74.

    Google Scholar 

  2. Mason AY. Surgical access to the rectum-a transsphincteric exposure. J R Soc Med 1970;63:91–4.

    Google Scholar 

  3. Graham RA, Garnsey L, Jessup JM. Local excision of rectal carcinoma. Am J Surg 1990;160:306–12.

    PubMed  Google Scholar 

  4. Köckerling F, Hermanek P, Gall FP. Ergebnisse der lokalen therapic in erlangen. In: Hermanek P, Marzoli GP, eds. Lokale therapie des rektumkarzinoms. Berlin: Springer, 1994:121–30.

    Google Scholar 

  5. Hermanek P. A pathologist's point of view on endoscopically removed polyps of the colon and rectum. Acta Hepatogastroenterol 1978;25:169–70.

    Google Scholar 

  6. Hermanek P. Onkologische und histopathologische grundlagen einer lokalen therapie in kurativer intention. In: Hermanek P, Marzoli GP, eds. Lokale therapie des rektumkarzinoms. Berlin: Springer, 1994:7–14.

    Google Scholar 

  7. Buess G, Hutterer F, TheiΒ J,et al. Das system für die transanale endoskopische rectumoperation. Chirurg 1984;55:677–80.

    PubMed  Google Scholar 

  8. Buess G, Mentges B, Manncke K,et al. Minimal invasive surgery in the local treatment of rectal cancer. Int J Colorectal Dis 1991;6:77–81.

    PubMed  Google Scholar 

  9. Buess G, Mentges B. Transanal endoscopic microsurgery (TEM). Minim Invasive Ther 1992;1:101–9.

    Google Scholar 

  10. Buess G, Mentges M, Manncke K,et al. Technique and results of transanal endoscopic microsurgery in early rectal cancers. Am J Surg 1992;163:63–70.

    PubMed  Google Scholar 

  11. Buess G. Review: transanal endoscopic microsurgery (TEM). J R Coll Surg Edinb 1993;38:239–45.

    PubMed  Google Scholar 

  12. Mentges B, Buess G. Transanal endoscopic microsurgery in the treatment of rectal tumours. Perspect Colon Rectal Surg 1991;4:265–79.

    Google Scholar 

  13. Saclarides TJ, Smith L, Ko ST, Orkin B, Buess G. Transanal endoscopic microsurgery. Dis Colon Rectum 1992;35:1183–91.

    PubMed  Google Scholar 

  14. Buess G. Transanale endoskopische mikrochirurgie. In: Buess G, ed. Endoskopie: von der diagnostik bis zur neuen chirurgie. Köln: Deutscher Ärzte-Verlag, 1990:288–311.

    Google Scholar 

  15. Buess G, Kipfmüller K, Hack D,et al. Technique of transanal endoscopic microsurgery. Surg Endosc 1988;2:71–5.

    PubMed  Google Scholar 

  16. Farin G. Pneumatically controlled bipolar cutting instrument. Endosc Surg Allied Technol 1993;1:97–101.

    PubMed  Google Scholar 

  17. Buess G, Kipfmüller K, Ibald R,et al. Transanale endoskopische mikrochirurgie beim rectumcarcinom. Chirurg 1989;60:901–4.

    PubMed  Google Scholar 

  18. Parks AG. A technique for excising extensive villous papillomatous change in the lower rectum. J R Soc Med 1968;61:441–2.

    Google Scholar 

  19. HÄring R, Karavias Th, Konradt J. Die posteriore proktorektotomie. Chirurg 1978;49:265–71.

    PubMed  Google Scholar 

  20. Schiessel R, Wunderlich M, Karner-Hanusch J. Transanale excision und anastomosentechnik. Chirurg 1986;57:773–8.

    PubMed  Google Scholar 

  21. Gall FP, Hermanek P. Die erweiterte lymphknotendissektion beim magen- und colorektalen karzinom. Chirurg 1988;59:202–10.

    PubMed  Google Scholar 

  22. Kessler H, Hermanek P, Wiebelt H. Operative mortality in carcinoma of the rectum: results of the German Multicentre Study. Int J Colorectal Dis 1993;8:158–66.

    PubMed  Google Scholar 

  23. Fielding LP, Phillips RK, Hittinger R. Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet 1989;1:595–7.

    PubMed  Google Scholar 

  24. Ondrula DP, Nelson RL, Prasad ML,et al. Multifactorial index of preoperative risk factors in colon resections. Dis Colon Rectum 1992;35:117–22.

    PubMed  Google Scholar 

  25. Safi F, Beger HG. MorbiditÄt und letalitÄt der operativen therapie des colorectalen carcinoms. Chirurg 1994;65:127–31.

    PubMed  Google Scholar 

  26. Gall FP, Hermanek P. Wandel und derzeitiger stand der chirurgischen behandlung des colorectalen carcinoms. Chirurg 1992;63:227–34.

    PubMed  Google Scholar 

  27. Heberer G, Denecke H, Demmel N, Wirsching R. Local procedures in the management of rectal cancer. World J Surg 1987;11:499–503.

    PubMed  Google Scholar 

  28. Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 1978;135:505–11.

    PubMed  Google Scholar 

  29. Mentges B, Bue\ G, Effinger G, Becker HD. Long term results after local therapy of rectal cancer. Minim Invasive Ther 1994;3:16.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery of the Eberhard Karls University Hospital, Tübingen, Germany

    B. Mentges M.D., G. Buess M.D., D. Schäfer M.D., K. Manncke M.D. & H. D. Becker M.D.

Authors
  1. B. Mentges M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Buess M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Schäfer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Manncke M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. D. Becker M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Mentges, B., Buess, G., Schäfer, D. et al. Local therapy of rectal tumors. Dis Colon Rectum 39, 886–892 (1996). https://doi.org/10.1007/BF02053987

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02053987

Key words

Search

Navigation