Center for Minimally Invasive Surgery, Dipartimento di Discipline Medico Chirurgiche, Università di Torino, 10126 Torino, Italy.
Dis Colon Rectum. 2009 Nov;52(11):1831-6. doi: 10.1007/DCR.0b013e3181b14d2d.
Abdominal resection for rectal neoplasms is associated with significant morbidity. Local excision with retractors can be proposed only for distal rectal lesions. With this retrospective review of our prospective series of transanal endoscopic microsurgery procedures, we wanted to verify the advantages of local treatment in terms of disease recurrence and complication rates.
Indications for transanal endoscopic microsurgery were adenoma, early carcinoma, rectal ulcers, carcinoid tumors, gastrointestinal stromal tumors, and leiomyosarcoma apparently located in the extraperitoneal rectum. We analyzed operating time, morbidity and mortality rates, length of hospital stay, staging discrepancy, recurrence rate, and oncological outcome.
From January 1993 to January 2007, 300 patients underwent transanal endoscopic microsurgery at our institution. The mean operating time was 66 minutes. The peritoneum was inadvertently opened in 13 cases. The overall morbidity rate was 7.7%. The mean hospital stay was five days. Histology demonstrated cancer in 90 patients. At a mean follow-up of 60 months, the recurrence rate was zero in pT1, 24% in pT2, and 50% in pT3. The overall estimated five-year survival rate was 87%, and the disease-free survival rate was 82%.
Transanal endoscopic microsurgery is safe and effective in the treatment of adenoma and pT1 carcinoma; it carries a lower morbidity than conventional surgery and a recurrence rate comparable to that of conventional surgery.
直肠肿瘤的腹部切除术与显著的发病率相关。只有对于直肠远端病变才能采用牵拉器辅助的局部切除术。通过回顾性分析我们的经肛门内镜微创手术的前瞻性系列研究，我们旨在验证局部治疗在疾病复发和并发症发生率方面的优势。
经肛门内镜微创手术的适应证为腺瘤、早期癌、直肠溃疡、类癌肿瘤、胃肠道间质肿瘤和明显位于腹膜外直肠的平滑肌肉瘤。我们分析了手术时间、发病率和死亡率、住院时间、分期差异、复发率和肿瘤学结果。
1993 年 1 月至 2007 年 1 月，我们机构有 300 例患者接受了经肛门内镜微创手术。平均手术时间为 66 分钟。13 例无意中切开了腹膜。总发病率为 7.7%。平均住院时间为 5 天。组织学显示 90 例患者患有癌症。在平均 60 个月的随访中，pT1 患者的复发率为 0%，pT2 为 24%，pT3 为 50%。总的估计五年生存率为 87%，无病生存率为 82%。
经肛门内镜微创手术治疗腺瘤和 pT1 癌是安全有效的；它的发病率低于传统手术，复发率与传统手术相当。
