经肛门内镜显微手术切除pT1期直肠肿瘤

Transanal endoscopic microsurgical resection of pT1 rectal tumors.

作者信息

Floyd Nadine Duhan, Saclarides Theodore J

机构信息

Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.

出版信息

Dis Colon Rectum. 2006 Feb;49(2):164-8. doi: 10.1007/s10350-005-0269-4.

DOI:10.1007/s10350-005-0269-4

PMID:16362801

Abstract

PURPOSE

Transanal endoscopic microsurgery has emerged as an improved method of transanal excision of neoplasms because its enhanced visibility, superior optics, and longer reach permit a more complete excision and precise closure. This study will show that transanal endoscopic microsurgical treatment of pT1 rectal cancers is safe and achieves low local recurrence and high survival rates.

METHODS

Retrospective review performed of all pT1 rectal cancers treated by a single surgeon (TS) using transanal endoscopic microsurgery between 1991 and 2003. Patient age, gender, tumor distance from the anal verge, lesion size, operative time, blood loss, complications, recurrence, and survival rates were prospectively recorded.

RESULTS

Fifty-three patients (average age, 65.6 (range, 31-89) years) were studied. Forty-nine percent were male. Average tumor distance from the anal verge was 7 (range, 0-13) cm; average size was 2.4 (range, 1-10) cm. Radiation and/or chemotherapy were not administered. Sixteen patients had pT1 lesions removed piecemeal during colonoscopy; there was no residual tumor after transanal endoscopic microsurgical resection of the polyp site. Mean follow-up was 2.84 years. Fifty-one percent had longer than two-year follow-up. For the entire group, there were four recurrences (7.5 percent) occurring at 9 months, 15 months, 16 months, and 11 years. Two were treated with abdominoperineal resection, one with low anterior resection, and one with fulguration alone. There were no recurrences in the 16 patients who had excision of the polypectomy site. If excluded, recurrence was 11 percent (4/37). Patients were examined at three-month intervals for the first two years and every six months thereafter. There have been no cancer-related deaths.

CONCLUSIONS

Transanal endoscopic microsurgical resection of pT1 rectal cancers yields low recurrence rates. Close follow-up permits curative salvage for those that do recur. Transanal excision remains a viable option.

摘要

目的

经肛门内镜显微手术已成为一种改良的经肛门肿瘤切除方法，因为其增强的视野、卓越的光学性能和更远的操作距离允许更完整的切除和精确的缝合。本研究将表明，经肛门内镜显微手术治疗pT1期直肠癌是安全的，且能实现低局部复发率和高生存率。

方法

对1991年至2003年间由一位外科医生（TS）使用经肛门内镜显微手术治疗的所有pT1期直肠癌进行回顾性研究。前瞻性记录患者的年龄、性别、肿瘤距肛缘的距离、病变大小、手术时间、失血量、并发症、复发情况和生存率。

结果

共研究了53例患者（平均年龄65.6岁，范围31 - 89岁）。49%为男性。肿瘤距肛缘的平均距离为7cm（范围0 - 13cm）；平均大小为2.4cm（范围1 - 10cm）。未进行放疗和/或化疗。16例患者在结肠镜检查期间分块切除了pT1病变；经肛门内镜显微手术切除息肉部位后无残留肿瘤。平均随访时间为2.84年。51%的患者随访时间超过两年。在整个组中，有4例复发（7.5%），分别发生在9个月、15个月、16个月和11年。2例接受了腹会阴联合切除术，1例接受了低位前切除术，1例仅接受了电灼治疗。在切除息肉切除部位的16例患者中无复发。如果排除这16例患者，复发率为11%（4/37）。患者在头两年每三个月检查一次，此后每六个月检查一次。无癌症相关死亡病例。