Colorectal Surgical Unit, Department of Surgery, S. Giovanni Hospital, Rome, Italy.
Dis Colon Rectum. 2012 Mar;55(3):262-9. doi: 10.1097/DCR.0b013e318241ef22.
Transanal endoscopic microsurgery is a faster and safer alternative to traditional surgical treatment of adenomas and low-risk (T1) rectal tumors. However, although overall survival appears similar, transanal endoscopic microsurgery has been shown to have higher recurrence rates.
The aim of this study was to investigate the management of patients with local recurrence after transanal endoscopic microsurgery and to evaluate their long-term outcome.
This study was a retrospective review of medical records.
Patients were treated at a large tertiary-care hospital in Rome, Italy, between 1990 and 2011.
Of 298 patients who underwent local excision with transanal endoscopic microsurgery, 144 patients with rectal adenocarcinoma were included in the study.
Local excision was performed with transanal endoscopic microsurgery. In all cases complete full-thickness excision was attempted.
Patient characteristics, operative record, pathology report, and tumor recurrence were analyzed. Survival was calculated using the Kaplan-Meyer method and groups were compared with the log-rank test.
Tumors were classified as pT1 in 86 patients (59.7%), pT2 in 38 (26.4%), and pT3 in 20 (13.9%). Median follow-up was 85 (range, 3-234) months. Median time to recurrence was 11.5 (range, 1-62) months; 44 patients had local or distal recurrence or both. The rate of local recurrence for patients with pT1 tumors was 11.6% (10/86). A total of 27 patients (18.8%) with local recurrence were eligible for salvage surgery: 17 had radical salvage resection, 9 had transanal re-excision, and 1 refused surgery. Overall 5-year survival was 83% in all 144 patients, and 92% in patients with pT1 tumors. The overall 5-year survival rate was higher in patients who had the radical salvage procedure than in those who had transanal re-excision (69% vs 43%; p = 0.05).
The study was limited by its retrospective nature, lack of technology at the beginning of the study, and the mixed nature of the study group.
The outcome after transanal excision for rectal cancer depends on close surveillance for early detection of recurrence. In patients able to undergo surgery, endoluminal or pelvic recurrence should be treated with an immediate radical salvage operation. Overall long-term survival after local excision with transanal endoscopic microsurgery followed by radical salvage surgery in cases of local recurrence is comparable to overall survival after initial radical surgery.
经肛门内镜微创手术是一种比传统手术治疗腺瘤和低危（T1）直肠肿瘤更快、更安全的选择。然而，尽管总体生存率相似，但经肛门内镜微创手术的复发率更高。
本研究旨在探讨经肛门内镜微创手术后局部复发患者的治疗方法，并评估其长期预后。
这是一项回顾性病历研究。
患者在意大利罗马的一家大型三级保健医院接受治疗，时间为 1990 年至 2011 年。
298 例接受经肛门内镜微创手术局部切除的患者中，纳入本研究的直肠腺癌患者为 144 例。
采用经肛门内镜微创手术进行局部切除。所有病例均尝试完全全层切除。
患者特征、手术记录、病理报告和肿瘤复发情况。采用 Kaplan-Meier 法计算生存率，并采用对数秩检验比较组间差异。
肿瘤分期为 pT1 的患者 86 例（59.7%），pT2 的患者 38 例（26.4%），pT3 的患者 20 例（13.9%）。中位随访时间为 85 个月（范围，3-234 个月）。中位复发时间为 11.5 个月（范围，1-62 个月）；44 例患者出现局部或远端复发或两者兼有。pT1 肿瘤患者的局部复发率为 11.6%（10/86）。27 例（18.8%）局部复发患者适合接受挽救性手术：17 例行根治性挽救性切除术，9 例行经肛门再切除术，1 例拒绝手术。144 例患者的 5 年总生存率为 83%，pT1 肿瘤患者的 5 年总生存率为 92%。接受根治性挽救性手术的患者 5 年总生存率高于接受经肛门再切除术的患者（69% vs 43%；p=0.05）。
本研究受限于其回顾性性质、研究初期缺乏技术以及研究组的混合性质。
经肛门切除直肠癌的结果取决于密切监测以早期发现复发。对于能够接受手术的患者，腔内或盆腔复发应立即行根治性挽救性手术。经肛门内镜微创手术局部切除后局部复发患者行根治性挽救性手术后的长期总生存率与初始根治性手术后的总生存率相当。
