BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by th...BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.展开更多
BACKGROUND Trans-anal endoscopic microsurgery(TEM)enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer.The rectum and retro-rect...BACKGROUND Trans-anal endoscopic microsurgery(TEM)enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer.The rectum and retro-rectal space might be the origin of uncommon neoplasms,benign and aggressive,certain require radical trans-abdominal surgery,while others can be treated by a less aggressive approach.In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years.METHODS Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution.Patients were discharged once diet was well tolerated and no complications were identified.They were evaluated at 3 wk post operatively,then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology.Clinical examination and rectoscopy were performed during each of the follow-up visits.RESULTS Out of 198 patients who underwent TEM during the study period,18 had non-adenomatous rectal or retro-rectal lesions.Mean age was 47 years.The mean size of the lesions was 2.9 mm,with a mean distance from the anal margin of 7.9 cm.Mean surgical time was 97.8 min.There were no intra-operative neither late post-operative complications.Mean length of stay was 2.5 d.Mean patient follow-up duration was 42 mo.CONCLUSION TEM allows for reduced morbidity given its minimally invasive nature.Surgeons should be familiar with the technique but careful patient selection should be considered.It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes.We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.展开更多
BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery(TEM).Local excision is an acceptable technique for high-risk and elderly patients,but th...BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery(TEM).Local excision is an acceptable technique for high-risk and elderly patients,but there are hardly any data regarding young patients.AIM To describe TEM outcomes in patients under 50 years of age.METHODS We collected demographic,clinical,and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018.RESULTS During the study period,a total of 26 patients under the age of 50 years underwent TEM procedures.Their mean age was 43.3 years.Eleven(42.0%)were male.The mean operative time was 67 min,and the mean tumor size was 2.39 cm,with a mean anal verge distance of 8.50 cm.No major intraoperative or postoperative complications were recorded.The median length of stay was 2 d.Seven(26.9%)lesions were adenomas with low-grade dysplasia,four(15.4%)were high-grade dysplasia adenomas,two were T1 carcinomas(7.8%),and three were T2 carcinomas(11.5%).No residual disease was found following endoscopic polypectomy in two patients(7.8%),but four(15.4%)had other pathologies.Surgical margins were negative in all cases.Local recurrence was detected in one patient 33 mo following surgery.CONCLUSION Among young adult patients,TEM for benign rectal lesions has excellent outcomes.It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer.In some cases,it may be considered an alternative to radical surgery.展开更多
Purpose: Despite many scientific advances, Regenerative Medicine is still in the preclinical stages in many areas. In this article, we intend to discuss the role of microsurgery in the bench-to-bedside transition of s...Purpose: Despite many scientific advances, Regenerative Medicine is still in the preclinical stages in many areas. In this article, we intend to discuss the role of microsurgery in the bench-to-bedside transition of such primary findings. Method: By searching the papers related to the history of Regenerative Medicine (RM) and the news of Tissue Engineering (TE) in orthopedics in Pubmed, Scopus, and Google Scholar databases, we accessed a complete archive of various topics related to this field. Result: We first assessed the history and achievements of regenerative medicine, then we realized the importance of translational medical sciences and the role of animal models in this incipient phenomenon. Finally, after mastering the capabilities of microsurgery and the useful contribution of this technique to the advancement of clinical applications of regenerative medicine in various branches such as skin, skeletal system, nerves, and blood vessels, we decided to express the gist of our studies through this article. Conclusion: Considering the widespread use of small animals in regenerative medicine projects and the inevitable role of microsurgery in performing the best intervention on these animal models, the significant progress of regenerative medicine clinical application requires special attention to microsurgery in associated research.展开更多
目的探讨显微外科手术治疗重症高血压性脑桥出血[出血量>5 mL、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)3~4分]的效果。方法回顾性分析2016年1月—2021年5月临沂市中医医院脑血管病中心内科保守治疗的重症高血压性脑桥出血患者[出...目的探讨显微外科手术治疗重症高血压性脑桥出血[出血量>5 mL、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)3~4分]的效果。方法回顾性分析2016年1月—2021年5月临沂市中医医院脑血管病中心内科保守治疗的重症高血压性脑桥出血患者[出血量(8.35±1.64)mL,GCS评分3~4分]共19例为内科治疗组;同期行CT定位血肿腔穿刺的18例重症高血压性脑桥出血患者[出血量(9.09±1.43)mL,GCS评分3~4分]为穿刺治疗组;同期显微外科手术治疗的21例重症高血压性脑桥出血患者[出血量(8.79±1.35)mL、GCS评分3~4分]为手术治疗组。按格拉斯哥预后评分(Glasgow Outcome Scale,GOS)评估预后,比较3组患者1、3个月存活患者例数。结果内科治疗组患者1个月时按GOS评分重残和植物状态生存10例,死亡9例;3个月时按GOS评分重残和植物状态生存8例,死亡2例。穿刺治疗组患者术后1月时按GOS评分重残和植物状态生存12例,死亡6例;术后3月时按GOS评分重残和植物状态生存11例,死亡1例。手术治疗组患者术中无死亡病例,术后患者自主呼吸均逐渐恢复,术后2周未出现多器官功能衰竭及电解质紊乱,2周时无死亡病例,术后1个月时按GOS评分:重残和植物状态生存20例,死亡1例;术后3个月时按GOS评分:重残和植物状态生存18例,死亡2例。1、3个月时比较内科治疗组、穿刺治疗组和手术治疗组存活患者,差异有统计学意义(χ^(2)=9.496、8.294,P<0.05)。结论对重症脑桥出血患者早期行显微外科手术治疗是简便、安全、有效的治疗方法,配合规范化神经外科重症管理,与穿刺治疗和内科治疗相比可以明显降低患者病死率。展开更多
文摘BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.
文摘BACKGROUND Trans-anal endoscopic microsurgery(TEM)enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer.The rectum and retro-rectal space might be the origin of uncommon neoplasms,benign and aggressive,certain require radical trans-abdominal surgery,while others can be treated by a less aggressive approach.In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years.METHODS Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution.Patients were discharged once diet was well tolerated and no complications were identified.They were evaluated at 3 wk post operatively,then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology.Clinical examination and rectoscopy were performed during each of the follow-up visits.RESULTS Out of 198 patients who underwent TEM during the study period,18 had non-adenomatous rectal or retro-rectal lesions.Mean age was 47 years.The mean size of the lesions was 2.9 mm,with a mean distance from the anal margin of 7.9 cm.Mean surgical time was 97.8 min.There were no intra-operative neither late post-operative complications.Mean length of stay was 2.5 d.Mean patient follow-up duration was 42 mo.CONCLUSION TEM allows for reduced morbidity given its minimally invasive nature.Surgeons should be familiar with the technique but careful patient selection should be considered.It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes.We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.
文摘BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery(TEM).Local excision is an acceptable technique for high-risk and elderly patients,but there are hardly any data regarding young patients.AIM To describe TEM outcomes in patients under 50 years of age.METHODS We collected demographic,clinical,and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018.RESULTS During the study period,a total of 26 patients under the age of 50 years underwent TEM procedures.Their mean age was 43.3 years.Eleven(42.0%)were male.The mean operative time was 67 min,and the mean tumor size was 2.39 cm,with a mean anal verge distance of 8.50 cm.No major intraoperative or postoperative complications were recorded.The median length of stay was 2 d.Seven(26.9%)lesions were adenomas with low-grade dysplasia,four(15.4%)were high-grade dysplasia adenomas,two were T1 carcinomas(7.8%),and three were T2 carcinomas(11.5%).No residual disease was found following endoscopic polypectomy in two patients(7.8%),but four(15.4%)had other pathologies.Surgical margins were negative in all cases.Local recurrence was detected in one patient 33 mo following surgery.CONCLUSION Among young adult patients,TEM for benign rectal lesions has excellent outcomes.It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer.In some cases,it may be considered an alternative to radical surgery.
文摘Purpose: Despite many scientific advances, Regenerative Medicine is still in the preclinical stages in many areas. In this article, we intend to discuss the role of microsurgery in the bench-to-bedside transition of such primary findings. Method: By searching the papers related to the history of Regenerative Medicine (RM) and the news of Tissue Engineering (TE) in orthopedics in Pubmed, Scopus, and Google Scholar databases, we accessed a complete archive of various topics related to this field. Result: We first assessed the history and achievements of regenerative medicine, then we realized the importance of translational medical sciences and the role of animal models in this incipient phenomenon. Finally, after mastering the capabilities of microsurgery and the useful contribution of this technique to the advancement of clinical applications of regenerative medicine in various branches such as skin, skeletal system, nerves, and blood vessels, we decided to express the gist of our studies through this article. Conclusion: Considering the widespread use of small animals in regenerative medicine projects and the inevitable role of microsurgery in performing the best intervention on these animal models, the significant progress of regenerative medicine clinical application requires special attention to microsurgery in associated research.
