Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C-1077, New York, NY 10065, USA.
J Gastrointest Surg. 2011 Jun;15(6):958-62. doi: 10.1007/s11605-011-1496-8. Epub 2011 Apr 9.
Transanal endoscopic microsurgery is an alternative to transanal excision or radical surgery for benign and carefully selected malignant rectal tumors. Advantages over transanal excision include better visualization, access to more proximal lesions, higher likelihood of negative margins, and lower recurrence rates. Compared to radical resection, patients experience lower rates of morbidity and mortality but may have higher rates of local recurrence.
A review of a prospectively maintained database of patients scheduled for transanal endoscopic microsurgery was performed.
Ninety-three patients underwent 96 procedures for 13 carcinoid tumors, 1 submucosal mass, 46 adenomas, 12 in situ adenocarcinomas, and 21 invasive adenocarcinomas. Of these cases, 81.2% was successfully completed. There were nine complications (11.5%). Final pathology demonstrated 33 in situ and invasive adenocarcinomas. The mean follow-up was 25.9 months. The four recurrences (12.1%) occurred in: one tubulovillous adenoma, two in situ carcinomas, and one T2 lesion.
Transanal endoscopic microsurgery is appropriate for benign lesions such as carcinoid tumors and adenomas and can also be curative in carefully selected patients with early-stage invasive rectal cancer. In cases of invasive adenocarcinoma, it should be reserved for low-risk cancers in patients who accept the possible increased risk of recurrence.
经肛门内镜微创手术是一种替代经肛门切除或根治性手术治疗良性和经仔细选择的恶性直肠肿瘤的方法。与经肛门切除相比，其优势包括更好的可视化、能够到达更靠近近端的病变、更高的阴性切缘概率和更低的复发率。与根治性切除相比，患者的发病率和死亡率较低，但局部复发率可能较高。
对接受经肛门内镜微创手术的患者的前瞻性维护数据库进行了回顾。
93 名患者接受了 96 次治疗，用于治疗 13 例类癌肿瘤、1 例黏膜下肿块、46 例腺瘤、12 例原位腺癌和 21 例浸润性腺癌。其中 81.2%的手术成功完成。有 9 例（11.5%）发生并发症。最终病理学显示 33 例原位和浸润性腺癌。平均随访时间为 25.9 个月。4 例（12.1%）复发：1 例管状绒毛状腺瘤、2 例原位癌和 1 例 T2 病变。
经肛门内镜微创手术适用于类癌肿瘤和腺瘤等良性病变，也可对早期浸润性直肠癌的精心选择患者进行治愈。对于浸润性腺癌病例，应将其保留给接受可能增加复发风险的低危癌症患者。
