BACKGROUND

The incidence of colon adenomas reaches 25% in patients over 40 years of age. It is well known that the timely removal of benign neoplasms of the colon makes it possible to prevent the development of cancer. Endoscopic methods of removal of adenomas and early colon cancer have long been the standard of treatment for the disease. However, in the case of choosing the method of treatment of large formations of the rectum, certain contradictions can be encountered regarding the choice of the method of treatment by transanal endomicrosurgery (TEMS) or by dissection in the submucosal layer (ESD)

OBJECTIVE

To present the first experience of resection of the rectal mucosa with dissection in the submucosal layer (ESD) in benign and malignant tumors.

MATERIAL AND METHODS

The experience of treating 16 patients with epithelial formations of the rectum by dissection in the submucosal layer was analyzed. The selection criteria were epithelial tumors with exophytic growth, an average size of 5.5 cm, histologically corresponding to adenomas with dysplasia of low (n-9) or high (n-7) degree. Intraoperatively, a complication was recorded in one patient in the form of a point perforation of the colon wall. The perforation hole is sewn with titanium clips.

RESULTS

In all cases, it was possible to remove the tumor in a single block. The average duration of the operation was 270 minutes. As a result of the final histological examination: adenoma with severe dysplasia n-13, highly differentiated adenocarcinoma ap-3. At the same time, in 2 patients — sm0, in 1 patient — sm1 on the Kikuchi scale. Resection edges R-0 in 100% of observations. No complications were detected in the postoperative period. Patients are registered with an oncologist. The control study is performed after 3—6—12 months. Relapse was not detected in any observation.

CONCLUSIONS

1. Endoscopic dissection in the submucosal layer and transanal endoscopic microsurgical resection in «early cancer» of the rectum or in adenomas with varying degrees of dysplasia are regulated by national clinical guidelines. 2. All other things being equal, preference should be given to ESD technology as the least traumatic. 3. The prospects for improving the results of endoscopic resection in the submucosal layer consist in improving methods for visualizing the depth of the lesion of the intestinal wall and identifying indirect signs of invasive carcinoma (narrow-spectrum endoscopy, zoom-endoscopy, chromoscopy, ultrasonography).