The Texas Endosurgery Institute, San Antonio, TX 78222, USA.
Surg Endosc. 2013 Jan;27(1):127-32. doi: 10.1007/s00464-012-2440-z. Epub 2012 Jul 26.
This prospective study focused on patients with rectal cancer who underwent transanal specimen extraction after laparoscopic anterior resection with total mesorectal excision and specifically aims to investigate whether the transanal approach can be accepted as a safe and effective method for extracting the malignant specimen from the peritoneal cavity.
A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal malignancy with various tumor-node-metastasis (TNM) classifications from April 1991 to May 2011 at the Texas Endosurgery Institute was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of size of the pathology and distance of rectal lesions from the anal verge.
179 anterior resections were completed laparoscopically with intracorporeal anastomosis and transanal specimen extraction. The operating time for the entire procedures including resection, anastomosis, and specimen extraction was 170.9 ± 51.2 min, blood loss during the procedures was 86.4 ± 37.7 ml, and distance of the lower edge of the lesion from the anal verge was measured to be 11.3 ± 7.3 cm. Postoperatively, three patients developed anastomotic leakage with a leak rate of 1.7%, and the overall major complication rate after the procedures was 5.0%. Length of hospital stay was 6.9 ± 2.8 days. Two-year follow-up showed development of anal stenosis in three patients (2.0%) and erectile dysfunction in one patient (0.36%) after surgery. Finally, 9 out of 179 patients who underwent laparoscopic anterior resection with transanal specimen extraction were confirmed to have cancer recurrence, with 2-year local recurrence rate of 5.0%.
Transanal specimen extraction in laparoscopic rectal cancer resection is a safe and effective approach with comparable local cancer recurrence rate and postoperative complication rates, suggesting it can be integrated into laparoscopic anterior resection for rectal cancer.
本前瞻性研究聚焦于接受腹腔镜全直肠系膜切除前切除术（TME）后经肛门标本提取的直肠癌患者，旨在探讨经肛门入路是否可作为一种安全有效的方法，从腹腔内提取恶性标本。
分析了 1991 年 4 月至 2011 年 5 月间在德克萨斯内窥镜外科研究所接受腹腔镜低位前切除术治疗各种肿瘤-淋巴结-转移（TNM）分期直肠癌的连续患者系列的前瞻性设计数据库。根据病理大小和直肠病变距肛缘的距离选择经肛门标本提取和腔内吻合的患者。
179 例前切除术经腹腔镜完成，行腔内吻合和经肛门标本提取。整个手术过程（包括切除、吻合和标本提取）的手术时间为 170.9 ± 51.2 分钟，术中出血量为 86.4 ± 37.7ml，病变下缘距肛缘的距离为 11.3 ± 7.3cm。术后 3 例发生吻合口漏，漏率为 1.7%，术后总体主要并发症发生率为 5.0%。住院时间为 6.9 ± 2.8 天。2 年随访发现 3 例（2.0%）患者发生肛门狭窄，1 例（0.36%）患者发生勃起功能障碍。最后，179 例接受腹腔镜前切除术和经肛门标本提取的患者中，有 9 例（5.0%）被确诊为癌症复发，2 年局部复发率为 5.0%。
经肛门标本提取在腹腔镜直肠癌切除术中是一种安全有效的方法，其局部癌症复发率和术后并发症发生率相当，表明其可整合到腹腔镜直肠癌前切除术中。
