Kang Liang, Chen Wen-Hao, Luo Shuang-Ling, Luo Yan-Xin, Liu Zhi-Hua, Huang Mei-Jin, Wang Jian-Ping
Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, People's Republic of China.
Surg Endosc. 2016 Jun;30(6):2552-62. doi: 10.1007/s00464-015-4521-2. Epub 2015 Aug 27.
Currently, the majority cases of the novel down-to-up transanal total mesorectal excision (TaTME) were performed in a hybrid approach with conventional laparoscopic assistance because of less operative difficulty. However, although cases are limited, the successes of TaTME in a pure approach (without laparoscopic assistance) indicate that the costly and less mini-invasive hybrid TaTME could be potentially avoided.
In the present single institutional, prospective study, we attempted to demonstrate the safety and feasibility of this approach in rectal cancer by evaluating the short-term results of our first 20 TaTME cases. For the majority of cases, we adopted a strategy that laparoscopic assistance was not introduced unless it was required during the planned pure TaTME procedure.
A total of 20 patients (12 males and 8 females) were analyzed in this study, including 11 cases (55 %) of pure TaTME and 9 cases (45 %) of hybrid TaTME. Overall, the median operative time was 200 min (range 70-420), along with a median estimated blood loss of 50 ml (range 20-800). Morbidity rate was 20 % (one urethral injury, two urinary retentions, one anastomotic hemorrhage and one mild anastomotic leak). The median number of harvested lymph nodes was 12 (range 1-20). All specimens were intact in mesorectum without positive distal and circumferential resection margins. Among the 15 patients who were preoperatively scheduled to undertake pure TaTME, four patients (26.7 %) required converting to laparoscopic assistance. Moreover, among these 15 patients, the results of the comparative analysis between female and male subgroups favor the former, suggesting easier operation in them.
This preliminary study demonstrates that TaTME in rectal cancer is safe and feasible. The strategy of not introducing laparoscopic assistance unless it is required while performing the planned pTaTME should be cautiously explored. Further studies with larger sample size and longer follow-up are warranted.
目前，由于手术难度较低，大多数新型经肛门全直肠系膜切除术（TaTME）病例采用与传统腹腔镜辅助相结合的混合术式进行。然而，尽管病例有限，但TaTME纯术式（无腹腔镜辅助）的成功表明，昂贵且微创性较差的混合TaTME可能有潜在的避免方式。
在本单中心前瞻性研究中，我们试图通过评估前20例TaTME病例的短期结果来证明该术式在直肠癌治疗中的安全性和可行性。对于大多数病例，我们采用一种策略，即除非在计划的纯TaTME手术过程中需要，否则不引入腹腔镜辅助。
本研究共分析了20例患者（12例男性和8例女性），其中包括11例（55%）纯TaTME和9例（45%）混合TaTME。总体而言，中位手术时间为200分钟（范围70 - 420分钟），中位估计失血量为50毫升（范围20 - 800毫升）。发病率为20%（1例尿道损伤、2例尿潴留、1例吻合口出血和1例轻度吻合口漏）。中位清扫淋巴结数为12个（范围1 - 20个）。所有标本的直肠系膜均完整，远端和环周切缘均为阴性。在术前计划进行纯TaTME的15例患者中，4例（26.7%）需要转为腹腔镜辅助。此外，在这15例患者中，女性和男性亚组的比较分析结果显示女性更具优势，提示女性手术操作更易。
这项初步研究表明，TaTME用于直肠癌治疗是安全可行的。对于在计划进行纯TaTME时除非需要否则不引入腹腔镜辅助的策略应谨慎探索。有必要进行更大样本量和更长随访时间的进一步研究。
