POTENTIAL OF TRANSANAL ENDOSCOPIC SURGERY IN THE MANAGEMENT OF EARLY RECTAL CANCER
DOI:
https://doi.org/10.32782/2226-2008-2025-3-11Keywords:
transanal endoscopic surgery, rectal cancer, minimally invasive surgery, indocyanine green, colorectal surgeryAbstract
Relevance. Transanal surgery for rectal pathology remains relatively rare. Transanal endoscopic surgery (TES) is performed at the early stages of rectal cancer. However, the issue of lymphogenic metastasis is still unresolved, as it is the most significant cause of local recurrence of rectal cancer and an unfavorable prognostic factor for this pathology.Aim of study – to increase the effectiveness of treatment of patients with early rectal cancer during transanal endoscopic operations using fluorescent methods for identifying sentinel lymph nodes.Materials and methods. Between 2009 and 2024, 175 patients underwent transanal endoscopic surgery at the Odesa Regional Clinical Hospital. Among them, 51 patients were diagnosed with rectal cancer preoperatively. In 15 patients with enlarged lymph nodes detected by MRI, an advanced TES procedure was performed using the ICG fluorescent dye.Results. The average tumor size was (3.8±1.2) cm (ranging from 1.8 to 4.7 cm). The follow-up period after transanal endoscopic resec- tions for rectal cancer ranged from 12 to 60 months. Recurrence of rectal cancer was identified in 3 patients (10.7%) with T1-2N0M0 cancer and in 5 patients (21.7%) with T3N0M0 cancer. We developed the advanced method of comprehensive treatment for early rectal cancer, namely the combination of transanal endoscopic surgeries with the use of the ICG fluorescent dye. It enables the identification and targeted study of sentinel lymph nodes in rectal cancer patients. Results of our research confirm the effectiveness and safety of TES procedures in patients with early-stage rectal cancer and substantiate the feasibility of expanding indications for this technique to include patients with more advanced stages (T1-T2), subject to careful patient selection.Conclusions. TES procedures for rectal cancer significantly reduce the incidence of intraoperative and postoperative complications.The use of ICG dye for fluorescent staining of sentinel lymph nodes allows for a more accurate determination of metastases, which has high diagnostic value.
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