Synchronous colorectal neoplasias: our experience about laparoscopic-TEM combined treatment
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Synchronous colorectal neoplasias: our experience about laparoscopic-TEM combined treatment Alessandro Spizzirri1*, Marco Coccetta1, Roberto Cirocchi1, Francesco La Mura1, Vincenzo Napolitano1, Maurizio Bravetti1, Daniele Giuliani1, Angelo De Sol1, Eleonora Pressi1, Stefano Trastulli1, Micol Sole Di Patrizi1, Nicola Avenia2, Francesco Sciannameo1
Abstract Synchronous colorectal neoplasias are defined as 2 or more primary tumors identified in the same patient and at the same time. The most voluminous synchronous cancer is called “first primitive” or “index” cancer. The aim of this work is to describe our experience of minimally invasive approach in patients with synchronous colorectal neoplasias. Since January 2001 till December 2009, 557 patients underwent colectomy for colorectal cancer at the Department of General and Emergency Surgery of the University of Perugia; 128 were right colon cancers, 195 were left colon cancers while 234 patients were affected by rectal cancers. We performed 224 laparoscopic colectomies (112 right, 67 left colectomies and 45 anterior resections of rectum), 91 Transanal Endoscopic Microsurgical Excisions (TEM) and 53 Trans Anal Excisions (TAE). In the same observation period 6 patients, 4 males and 2 females, were diagnosed with synchronous colorectal neoplasias. Minimal invasive treatment of colorectal cancer offers the opportunity to treat two different neoplastic lesions at the same time, with a shorter post-operative hospitalization and minor complications. According to our experience, laparoscopy and TEM may ease the treatment of synchronous diseases with a lower morbidity rate. Introduction Synchronous colorectal neoplasias, defined as 2 or more primary tumors identified in the same patient and at the same time, are caused by common genetic and environmental factors [1]. Since intraoperative palpation can miss up to 69% of the SN [2], currently, synchronous neoplastic lesions are usually diagnosed at a preoperative staging by colonoscopy or virtual colonoscopy; according to data from literature, 3% of the patients with SN are affected by different types of malignant lesions [3] while 33-55% show villous adenomas [4,5]. Literature also confirms the presence of primitive synchronous cancers [6]; malignant synchronous lesions are very rare, showing the following incidence: between 0,17% and
* Correspondence: [email protected] 1 General Surgery Department, St. Maria Hospital, Terni (TR), University of Perugia, Italy Full list of author information is available at the end of the article
0,69% in case of 2-3 synchronous lesions, 0,19% in case of 4-5 synchronous lesions [7]. The most voluminous synchronous cancer is called “first primitive” or “index” cancer. When the index cancer is located in the caecum, the incidence of left colon synchronous cancers is higher than when the index cancer is located in the left colon [8,9]. Colorectal adenomas standard treatment is usually represented by endoscopic polypectomy; in
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