Surgical Oncology Department, Val d'Aurelle Montpellier Cancer Institute, Montpellier, France.
Dis Colon Rectum. 2013 Apr;56(4):408-15. doi: 10.1097/DCR.0b013e3182756fa0.
In rectal surgery, some situations can be critical, such as anterior topography of locally advanced low tumors with a positive predictive radial margin, especially in a narrow pelvis of men who are obese. Transanal proctectomy is a new laparoscopic technique that uses the transanal endoscopic microsurgery device.
The aim of this study is to evaluate the technical feasibility of laparoscopic transanal proctectomy in patients with unfavorable features.
This is a single-center, prospective analysis of selected patients with rectal cancer operated on from January 2009 to June 2011.
Intraoperative details and short-term postoperative outcome were described.
Thirty men with advanced or recurrent low rectal tumors associated with unfavorable anatomical and/or tumor characteristics underwent a sphincter-sparing transanal endoscopic proctectomy. Twenty-nine patients had received preoperative treatment. We report a 6% conversion rate, no postoperative mortality, and a 30% morbidity rate. At the beginning of our experience, a urethral injury was diagnosed in 2 patients and easily sutured intraoperatively, without postoperative after-effect. The mesorectal resection was graded as "good" in all patients. R0 resection was achieved in 26 patients (87%). The short-term stoma closure rate was 85%. After a median follow-up of 21 months, 4 patients experienced locoregional recurrence alone. Overall survival rates at 12 and 24 months were 96.6% (95% CI, 78.0-99.5) and 80.5% (95% CI, 53.0-92.9). Relapse-free survival rates at 12 and 24 months were 93.3% (95% CI, 75.9-98.3) and 88.9% (95% CI, 69.0-96.3).
Although the transanal endoscopic proctectomy was performed by trained surgeons, we report a slight increase in early postoperative morbidity and relatively poor early outcome. There was a clear selection bias related to the study cohort exclusively composed of high-risk patients, but we need to be cautious before generalizing this technique.
The transanal endoscopic proctectomy is a feasible alternative surgical option to conventional laparoscopy for radical rectal resection in selected cases with unfavorable characteristics. Further investigations with larger cohorts are required to validate its safety and to clarify its best indication.
在直肠外科手术中，有些情况可能会很危急，例如局部晚期低位肿瘤前位，且预测切缘阳性，特别是在肥胖男性狭窄的骨盆中。经肛门直肠切除术是一种新的腹腔镜技术，使用经肛门内镜微创手术设备。
本研究旨在评估腹腔镜经肛门直肠切除术在具有不利特征的患者中的技术可行性。
这是一项单中心前瞻性分析，选择了 2009 年 1 月至 2011 年 6 月间接受直肠手术的直肠癌患者。
描述了术中细节和短期术后结果。
30 名男性患有晚期或复发性低位直肠肿瘤，伴有不利的解剖和/或肿瘤特征，接受了肛门括约肌保留的经肛门内镜直肠切除术。29 名患者接受了术前治疗。我们报告的转化率为 6%，无术后死亡，发病率为 30%。在我们经验的开始阶段，诊断出 2 例患者的尿道损伤，并且可以在术中轻松缝合，没有术后后遗症。所有患者的直肠系膜切除均被评为“良好”。26 例患者（87%）达到了 R0 切除。短期造口闭合率为 85%。中位随访 21 个月后，4 名患者仅出现局部复发。12 个月和 24 个月的总生存率分别为 96.6%（95%CI，78.0-99.5）和 80.5%（95%CI，53.0-92.9）。12 个月和 24 个月的无复发生存率分别为 93.3%（95%CI，75.9-98.3）和 88.9%（95%CI，69.0-96.3）。
尽管经肛门内镜直肠切除术由经过培训的外科医生进行，但我们报告早期术后发病率略有增加，早期结果相对较差。由于研究队列仅由高危患者组成，因此存在明显的选择偏倚，但在推广该技术之前，我们需要谨慎。
对于具有不利特征的选定病例，经肛门内镜直肠切除术是一种可行的替代传统腹腔镜直肠根治性切除术的手术选择。需要更大的队列研究来验证其安全性，并阐明其最佳适应证。
