1Colon and Rectal Surgery, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania 2Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota 3Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois.
Dis Colon Rectum. 2014 Apr;57(4):438-41. doi: 10.1097/DCR.0000000000000063.
Transanal endoscopic microsurgery has gained increasing popularity as a treatment alternative for early stage rectal neoplasms. With continued advances in technique and experience, more proximal rectal tumors are being surgically managed by using transanal endoscopic microsurgery with an intraperitoneal anastomosis.
The purpose of this study was to review the outcomes of patients who have undergone intraperitoneal anastomosis with the use of the transanal endoscopic microsurgery technique.
A prospective, single-surgeon database documented 445 consecutive patients undergoing transanal endoscopic microsurgery from October 1, 1996 through January 1, 2012. We retrospectively reviewed information from all patients who underwent transanal endoscopic microsurgery with an intraperitoneal anastomosis in this prospective database.
All procedures took place in an inpatient hospital setting.
All patients satisfied workup criteria to undergo surgery for rectal neoplasm.
All patients underwent transanal endoscopic microsurgery for rectal neoplasm.
Size and pathology of lesion, length of procedure, hospital stay, estimated blood loss, margin status, and complications were the outcomes measured.
Twenty-eight patients who underwent transanal endoscopic microsurgery had definitively documented intraperitoneal entry and anastomosis. Median follow-up was 12 months (range, 0.5-111 months). There were no operative mortalities. Procedure-related complications included urinary retention (11%), fever (11%), and fecal seepage (4%). Four patients (14%) had positive margins on final pathology. One patient (3%) required abdominal exploration for an anastomotic leak but did not require diversion.
Although this study analyzes prospectively collected data, it is nonetheless a retrospective analysis that can introduce bias. Because this is a single-center study with a relatively homogenous population, the results may not be generalizable. Our sample size may also be underpowered to detect clinically significant outcomes.
Transanal endoscopic microsurgery with intraperitoneal anastomosis can be safely performed without fecal diversion by experienced surgeons.
经肛门内镜微创手术作为早期直肠肿瘤的治疗选择越来越受欢迎。随着技术和经验的不断进步，越来越多的近端直肠肿瘤通过经肛门内镜微创手术和腹腔内吻合来进行手术治疗。
本研究旨在回顾接受经肛门内镜微创手术和腹腔内吻合术治疗的患者的结果。
一项前瞻性、单外科医生数据库记录了 1996 年 10 月 1 日至 2012 年 1 月 1 日期间接受经肛门内镜微创手术的 445 例连续患者。我们回顾性地审查了在这个前瞻性数据库中接受经肛门内镜微创手术和腹腔内吻合术的所有患者的信息。
所有手术均在住院医院进行。
所有患者均符合手术治疗直肠肿瘤的检查标准。
所有患者均因直肠肿瘤接受经肛门内镜微创手术。
病变的大小和病理、手术时间、住院时间、估计失血量、切缘状态和并发症。
28 例患者经肛门内镜微创手术有明确的腹腔内进入和吻合术记录。中位随访时间为 12 个月（范围，0.5-111 个月）。无手术死亡。与手术相关的并发症包括尿潴留（11%）、发热（11%）和粪便渗漏（4%）。4 例患者（14%）最终病理切缘阳性。1 例患者（3%）因吻合口漏而需要剖腹探查，但无需分流。
尽管本研究分析了前瞻性收集的数据，但它仍然是一项回顾性分析，可能会引入偏倚。由于这是一项单中心研究，且人群相对同质，因此结果可能不具有普遍性。我们的样本量也可能不足以检测到有临床意义的结果。
经验丰富的外科医生可以安全地进行经肛门内镜微创手术和腹腔内吻合术，而无需粪便转流。
