Denost Quentin, Adam Jean-Philippe, Pontallier Arnaud, Celerier Bertrand, Laurent Christophe, Rullier Eric
From the Department of Surgery, Colorectal Unit, CHU Bordeaux, Saint-Andre Hospital, France; and Université Bordeaux Segalen, Bordeaux, France.
Ann Surg. 2015 Jan;261(1):138-43. doi: 10.1097/SLA.0000000000000855.
Oncologic and functional outcomes were compared between transanal and transabdominal specimen extraction after laparoscopic coloanal anastomosis for rectal cancer.
Laparoscopic coloanal anastomosis is an attractive new surgical option in patients with low rectal cancer because laparotomy is not necessary due to transanal specimen extraction. Risks of tumor spillage and fecal incontinence induced by transanal extraction are not known.
Between 2000 and 2010, 220 patients with low rectal cancer underwent laparoscopic rectal excision with hand-sewn coloanal anastomosis. The rectal specimen was extracted transanally in 122 patients and transabdominally in 98 patients. End points were circumferential resection margin, mesorectal grade, local recurrence, survival, and functional outcome.
The mortality rate was 0.5% and surgical morbidity rate was 17%. The rate of positive circumferential resection margin was 9% and the mesorectum was graded complete in 79%, subcomplete in 12%, and incomplete in 9%. After a follow-up of 51 months (range, 1-151), the local recurrence rate was 4% and overall survival and disease-free survival rates were 83% and 70% at 5 years, respectively. The continence score was 6 (range, 0-20). There was no difference of mortality rate, morbidity rate, circumferential resection margin, mesorectal grade, local recurrence (4% vs 5%, P = 0.98), and disease-free survival rate (72% vs 68%, P = 0.63) between transanal and transabdominal extraction groups. Continence score was also similar (6 vs 6, P = 0.92).
Transanal extraction of the rectal specimen did not compromise oncologic and functional outcome after laparoscopic surgery for low rectal cancer and seems as a safe option to preserve the abdominal wall.
比较腹腔镜结直肠吻合术后经肛门和经腹标本取出术治疗直肠癌的肿瘤学和功能学结局。
腹腔镜结直肠吻合术是低位直肠癌患者一种有吸引力的新手术选择，因为经肛门取出标本无需开腹。经肛门取出标本导致肿瘤播散和大便失禁的风险尚不清楚。
2000年至2010年期间，220例低位直肠癌患者接受了腹腔镜直肠切除术并手工缝合结直肠吻合术。122例患者经肛门取出直肠标本，98例患者经腹取出。观察终点为环周切缘、直肠系膜分级、局部复发、生存率和功能结局。
死亡率为0.5%，手术并发症发生率为17%。环周切缘阳性率为9%，直肠系膜分级为完整的占79%，次完整的占12%，不完整的占9%。随访51个月（范围1 - 151个月）后，局部复发率为4%，5年总生存率和无病生存率分别为83%和70%。控便评分6分（范围0 - 20分）。经肛门和经腹取出标本组在死亡率、并发症发生率、环周切缘、直肠系膜分级、局部复发（4%对5%，P = 0.98）和无病生存率（72%对68%，P = 0.63）方面无差异。控便评分也相似（6分对6分，P = 0.92）。
低位直肠癌腹腔镜手术后经肛门取出直肠标本不影响肿瘤学和功能学结局，似乎是一种保留腹壁的安全选择。
