Departments of *Gastrointestinal Surgery †Gastroenterology, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS*, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Centre, Barcelona, Catalonia, Spain.
Ann Surg. 2015 Feb;261(2):221-7. doi: 10.1097/SLA.0000000000000865.
The aim of this study was to compare short-term results obtained with transanal total mesorectal excision (TME) and laparoscopic surgery.
Transanal TME appears as an alternative in the treatment of rectal cancer and other rectal disease. Natural orifices transluminal endoscopic surgery using the rectum as access in colorectal surgery is intuitively better suited than other access routes.
All consecutive patients with middle or low rectal cancer submitted to surgery were included into a prospective cohort and treated by transanal TME assisted by laparoscopy. They were compared with a retrospective cohort of consecutive patients of identical characteristics treated by laparoscopic TME in the immediate chronological period.
Thirty-seven patients were included in both study groups. No differences were observed between them with respect to baseline characteristics, thus emphasizing the comparability of both cohorts. Surgical time was higher in the laparoscopy group (252 ± 50 minutes) than in the transanal group (215 ± 60 minutes) (P < 0.01). Moreover, coloanal anastomosis was performed less frequently (16% vs 43%, respectively; P = 0.01) and distal margin was lower (1.8 ± 1.2 mm vs 2.7 ± 1.7 mm, respectively; P = 0.05) in the laparoscopy group than in the transanal one. Although there was no significant difference in 30-day postoperative complication rate (laparoscopy, 51% vs transanal, 32%; P = 0.16), early readmissions were more frequent in the laparoscopy group than in the transanal one (22% vs 6%, respectively; P = 0.03).
Evaluation of short-term outcomes demonstrated that transanal TME is a feasible and safe technique associated with a shorter surgical time and a lower early readmission rate.
本研究旨在比较经肛门全直肠系膜切除术（TME）和腹腔镜手术的短期结果。
经肛门 TME 似乎是治疗直肠癌和其他直肠疾病的一种替代方法。在结直肠手术中使用直肠作为通道的经自然腔道内镜外科手术，与其他通道相比，在直观上更具优势。
所有接受手术治疗的中低位直肠癌连续患者均被纳入前瞻性队列，并接受经肛门 TME 联合腹腔镜治疗。将他们与同一时期接受腹腔镜 TME 治疗的连续患者的回顾性队列进行比较。
两组均纳入 37 例患者。两组患者的基线特征无差异，从而强调了两组的可比性。腹腔镜组的手术时间（252 ± 50 分钟）明显高于经肛门组（215 ± 60 分钟）（P < 0.01）。此外，腹腔镜组的结肠直肠吻合术较少（16% vs 43%，P = 0.01），远端切缘较低（1.8 ± 1.2 毫米 vs 2.7 ± 1.7 毫米，P = 0.05）。腹腔镜组和经肛门组的 30 天术后并发症发生率（51% vs 32%，P = 0.16）无显著差异，但腹腔镜组的早期再入院率（22% vs 6%，P = 0.03）较高。
短期结果评估表明，经肛门 TME 是一种可行且安全的技术，具有较短的手术时间和较低的早期再入院率。
