Katsuno Hidetoshi, Maeda Koutarou, Koide Yoshikazu
Department of Surgery, Fujita Health University, Aichi, Japan.
Nihon Geka Gakkai Zasshi. 2011 Sep;112(5):309-12.
The most appropriate technique for local excision of early rectal cancer remains controversial. Surgeons are responsible for determining whether the intent of treatment is curative or palliative and which technique to employ. The aim of local excision is to perform full-thickness resection of early rectal cancer with sufficient surgical margins for pathologic study. Patients in whom lymph node metastasis is suspected should undergo additional surgery. Various procedures have been reported so far. Local excision techniques are currently most often performed via the transanal approach under direct visualization, which include conventional techniques and minimally invasive transanal surgery (MITAS), or transanal endoscopic microsurgery (TEM). MITAS and TEM provide access to more proximal tumors up to 20cm from the anal verge. While posterior approaches are useful to expose the rectal wall to facilitate local excision, these procedures are infrequently performed at present due to the significant associated morbidity, such as bowel fistulas and impaired anorectal function. In conclusion, it is essential to recognize the pros and cons of the various techniques when performing local excision for early rectal cancer.
早期直肠癌局部切除的最合适技术仍存在争议。外科医生负责确定治疗目的是根治性还是姑息性，以及采用哪种技术。局部切除的目的是对早期直肠癌进行全层切除，并留有足够的手术切缘用于病理研究。怀疑有淋巴结转移的患者应接受额外手术。目前已报道了各种手术方法。局部切除技术目前最常通过经肛门入路在直视下进行，包括传统技术和经肛门微创手术（MITAS）或经肛门内镜显微手术（TEM）。MITAS和TEM可用于处理距肛缘达20厘米的更靠近近端的肿瘤。虽然后路手术有助于暴露直肠壁以利于局部切除，但由于存在诸如肠瘘和肛门直肠功能受损等显著的相关发病率，目前这些手术很少进行。总之，在对早期直肠癌进行局部切除时，认识到各种技术的优缺点至关重要。
