Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, UK.
Colorectal Dis. 2014 Jan;16(1):2-14. doi: 10.1111/codi.12474.
A systematic analysis was conducted of trials comparing the effectiveness of transanal endoscopic microsurgery (TEMS) with radical resection (RR) for T1 and T2 rectal cancer.
An electronic search was carried out of trials reporting the effectiveness of TEMS and RR in the treatment of T1 and T2 rectal cancers.
Ten trials including 942 patients were retrieved. There was a trend toward a higher risk of local recurrence (odds ratio 2.78; 95% confidence interval 1.42, 5.44; z = 2.97; P < 0.003) and overall recurrence (P < 0.01) following TEMS compared with RR. The risk of distant recurrence, overall survival (odds ratio 0.90; 95% confidence interval 0.49, 1.66; z = 0.33; P = 0.74) and mortality was similar. TEMS was associated with a shorter operation time and hospital stay and a reduced risk of postoperative complications (P < 0.0001). The included studies, however, were significantly diverse in stage and grade of rectal cancer and the use of neoadjuvant chemoradiotherapy.
Transanal endoscopic microsurgery appears to have clinically measurable advantages in patients with early rectal cancer. The studies included in this review do not allow firm conclusions as to whether TEMS is superior to RR in the management of early rectal cancer. Larger, better designed and executed prospective studies are needed to answer this question.
系统分析比较经肛门内镜微创手术（TEMS）与根治性切除术（RR）治疗 T1 和 T2 期直肠癌疗效的试验。
检索报道 TEMS 和 RR 治疗 T1 和 T2 期直肠癌疗效的试验。
检索到 10 项试验，共纳入 942 例患者。与 RR 相比，TEMS 组局部复发风险（优势比 2.78；95%置信区间 1.42-5.44；z=2.97；P<0.003）和总体复发风险（P<0.01）更高。远处复发、总生存（优势比 0.90；95%置信区间 0.49-1.66；z=0.33；P=0.74）和死亡率无差异。TEMS 手术时间和住院时间更短，术后并发症风险更低（P<0.0001）。但纳入的研究在直肠癌的分期、分级和新辅助放化疗的应用方面存在显著差异。
TEMS 治疗早期直肠癌可能具有临床可衡量的优势。本综述纳入的研究不能确定 TEMS 是否优于 RR 治疗早期直肠癌。需要更大、设计和执行更好的前瞻性研究来回答这个问题。
