Wolthuis Albert M, Bislenghi Gabriele, de Buck van Overstraeten Anthony, D'Hoore André
Albert M Wolthuis, Gabriele Bislenghi, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, 3000 Leuven, Belgium.
World J Gastroenterol. 2015 Nov 28;21(44):12686-95. doi: 10.3748/wjg.v21.i44.12686.
To describe the role of Transanal total mesorectal excision (TaTME) in minimally invasive rectal cancer surgery, to examine the differences in patient selection and in reported surgical techniques and their impacts on postoperative outcomes and to discuss the future of TaTME.
MEDLINE (PubMed), EMBASE, and The Cochrane Library were systematically searched through the 1(st) of March 2015 using a predefined search strategy.
A total of 20 studies with 323 patients were included. Most studies were single-arm prospective studies with fewer than 100 patients. Multiple transanal access platforms were used, and the laparoscopic approach was either multi- or single port. The procedure was initiated transanally or transabdominally. If a simultaneous approach with 2 operating surgeons was chosen, the operative time was significantly reduced.
TaTME was also associated with better TME specimens and a longer distal resection margin. TaTME is thus feasible in expert hands, but the learning curve and safety profile are not well defined. Long-term follow-up regarding anal function and oncological outcomes should be performed in the future.
描述经肛门全直肠系膜切除术（TaTME）在微创直肠癌手术中的作用，探讨患者选择、所报道的手术技术差异及其对术后结局的影响，并讨论TaTME的未来发展。
采用预定义的检索策略，对截至2015年3月1日的MEDLINE（PubMed）、EMBASE和Cochrane图书馆进行系统检索。
共纳入20项研究，涉及323例患者。大多数研究为单臂前瞻性研究，患者少于100例。使用了多种经肛门入路平台，腹腔镜入路为多端口或单端口。手术可经肛门或经腹开始。如果选择两名手术医生同时进行手术，手术时间会显著缩短。
TaTME还与更好的直肠系膜标本和更长的远端切缘相关。因此，在专家手中TaTME是可行的，但学习曲线和安全性尚不明确。未来应进行关于肛门功能和肿瘤学结局的长期随访。
