Sgourakis George, Lanitis Sophocles, Gockel Ines, Kontovounisios Christos, Karaliotas Charilaos, Tsiftsi Katerina, Tsiamis Achilleas, Karaliotas Constantine C
Second Surgical Department and Surgical Oncology Unit of Korgialenio - Benakio, Red Cross Hospital, Athens, Greece.
Am Surg. 2011 Jun;77(6):761-72.
The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective comparative studies were evaluated. End-points included perioperative outcomes, margin involvement, disease-free and overall survival, and recurrence. The number of patients with major (odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.91) and overall postoperative complications (OR = 0.16, 95% CI 0.06-0.38) were significantly lower in TEM. The disease-free survival was higher in standard resection (SR) group compared with TEM (OR = 0.46, 95% CI 0.24-0.88). The number of patients with positive margins were less in the SR group (OR = 6.49, 95% CI 1.49-24.91), which was associated with lower local recurrence (OR = 4.92, 95% CI 1.81-13.41) and overall recurrence rate (OR = 2.03, 95% CI 1.15-3.57). No survival advantage was observed in favor of either procedure. TEM had lower rate of positive margins and longer disease-free survival when compared with transanal excision (TAE). TEM seems to be superior to SR concerning morbidity whilst less effective in obtaining negative surgical margins, and it is associated with higher local and overall recurrence. No survival advantage was observed in favor of either procedure. Unfavorable tumor preoperative histology does not seem to influence the selection between TEM and SR. TEM is more effective than TAE in obtaining negative surgical margins and shows a greater disease-free survival.
本研究的目的是评估经肛门内镜显微手术（TEM）作为I期直肠癌的手术策略。文献中缺乏关于TEM肿瘤学疗效的I级和II级证据。评估了三项随机对照研究、一项前瞻性研究和七项回顾性比较研究。终点指标包括围手术期结局、切缘受累情况、无病生存期和总生存期以及复发情况。TEM组主要术后并发症（优势比（OR）=0.24，95%置信区间（CI）0.07 - 0.91）和总体术后并发症（OR = 0.16，95% CI 0.06 - 0.38）的患者数量显著更低。与TEM组相比，标准切除术（SR）组的无病生存期更高（OR = 0.46，95% CI 0.24 - 0.88）。SR组切缘阳性的患者数量更少（OR = 6.49，95% CI 1.49 - 24.91），这与更低的局部复发率（OR = 4.92，95% CI 1.81 - 13.41）和总体复发率（OR = 2.03，95% CI 1.15 - 3.57）相关。未观察到哪种手术方式具有生存优势。与经肛门切除术（TAE）相比，TEM的切缘阳性率更低，无病生存期更长。在发病率方面，TEM似乎优于SR，但在获得阴性手术切缘方面效果较差，且与更高的局部和总体复发率相关。未观察到哪种手术方式具有生存优势。术前肿瘤组织学不良似乎不影响TEM和SR之间的选择。在获得阴性手术切缘方面，TEM比TAE更有效，且无病生存期更长。
