Digestive and Colorectal Surgery and Centre for Minimally Invasive Surgery, Dipartimento di Discipline Medico-Chirurgiche, University of Torino, Corso A. M. Dogliotti 14, 10126 Turin, Italy.
Surg Endosc. 2012 Sep;26(9):2594-600. doi: 10.1007/s00464-012-2238-z. Epub 2012 Apr 5.
Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a "tailored" approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma.
This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated.
Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12-216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4-33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003).
TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence.
经肛门内镜微创手术（TEM）彻底改变了经肛门手术的技术和结果，成为治疗大型直肠有蒂腺瘤的标准方法。然而，只有少数研究评估了局部复发的危险因素，以便推荐“量身定制”的方法。本研究旨在确定 TEM 治疗直肠腺瘤后复发的预测变量。
这是对我们机构接受 TEM 治疗的大型直肠有蒂腺瘤患者的前瞻性数据库进行的回顾性分析，随访时间至少为 12 个月。研究了年龄、性别、肿瘤直径、距肛门缘的距离、异型增生程度、组织学和边缘受累情况。
1993 年 1 月至 2010 年 7 月期间，293 例直肠腺瘤≥3cm 的患者接受了 TEM。术后发病率为 7.2%（21/293），无 30 天死亡率。在中位数为 110（范围为 12-216）个月的随访期间，13 例（5.6%）患者被诊断为局部复发。复发的中位时间为 10（范围为 4-33）个月，76.9%的复发发生在 TEM 后 12 个月内。单因素分析显示，肿瘤直径（p=0.007）和阳性边缘（p<0.001）是显著的危险因素，而多因素分析表明阳性边缘的存在是复发的唯一独立预测因素（p=0.003）。
TEM 为大型直肠良性病变的治疗提供了极好的肿瘤学结果，保证了在病理检查时切除边缘浸润的风险最小，这是复发的唯一危险因素。
