Pontallier Arnaud, Denost Quentin, Van Geluwe Bart, Adam Jean-Philippe, Celerier Bertrand, Rullier Eric
CHU Bordeaux, Department of Digestive Surgery, Saint André Hospital, University of Bordeaux, 1 rue Jean Burguet, 33075, Bordeaux Cedex, France.
Université Bordeaux Segalen, 33076, Bordeaux, France.
Surg Endosc. 2016 Nov;30(11):4924-4933. doi: 10.1007/s00464-016-4833-x. Epub 2016 Mar 4.
Preliminary results of the transanal approach for low rectal cancer suggest better oncological outcomes than the conventional laparoscopic approach. We currently report the functional results.
From 2008 to 2012, 100 patients with low rectal cancer and suitable for sphincter-saving resection were randomized between transanal and laparoscopic low rectal dissection. Patients derived from this randomized trial were enrolled for functional assessment. End points were bowel function (LARS bowel and Wexner continence scores) and urogenital function (IPSS, IIEF-5 and FSFI-6 scores) obtained by questionnaires sent to patients with a follow-up more than 12 months.
Overall, 76 patients were eligible and 72 responded to the questionnaire: 38 in the transanal group and 34 in the laparoscopic group. The bowel function did not differ between the transanal and the laparoscopic groups: LARS 36 versus 37 (p = 0.941) and Wexner 9 versus 10 (p = 0.786). The urologic function was also similar between the two groups: IPSS 5.5 versus 3.5 (p = 0.821). Among sexually active patients before surgery, 20 of 28 (71 %) patients in the transanal group and 9 of 23 (39 %) in the laparoscopic group maintained an activity after surgery (p = 0.02). Erectile function was also better in men after transanal compared to laparoscopic low rectal dissection: IIEF 17 versus 7 (p = 0.119).
Transanal approach for low rectal cancer did not change bowel and urologic functions compared to the conventional laparoscopic approach. However, there was a trend to a better erectile function with a significantly higher rate of sexual activity in the transanal group.
低位直肠癌经肛门入路的初步结果表明，其肿瘤学结局优于传统腹腔镜入路。我们现报告其功能结果。
2008年至2012年，100例适合保留括约肌切除术的低位直肠癌患者被随机分为经肛门低位直肠切除术组和腹腔镜低位直肠切除术组。来自该随机试验的患者被纳入功能评估。终点指标为通过向随访超过12个月的患者发送问卷获得的肠道功能（低位前切除综合征肠道和韦克斯纳失禁评分）和泌尿生殖功能（国际前列腺症状评分、国际勃起功能指数-5和女性性功能指数-6评分）。
总体而言，76例患者符合条件，72例回复了问卷：经肛门组38例，腹腔镜组34例。经肛门组和腹腔镜组的肠道功能无差异：低位前切除综合征评分为36对37（p = 0.941），韦克斯纳评分为9对10（p = 0.786）。两组的泌尿功能也相似：国际前列腺症状评分为5.5对3.5（p = 0.821）。在术前有性生活的患者中，经肛门组28例中的20例（71%）和腹腔镜组23例中的9例（39%）术后仍保持性生活（p = 0.02）。与腹腔镜低位直肠切除术相比，经肛门低位直肠切除术后男性的勃起功能也更好：国际勃起功能指数为17对7（p = 0.119）。
与传统腹腔镜入路相比，低位直肠癌经肛门入路未改变肠道和泌尿功能。然而，经肛门组有勃起功能更好的趋势，且性生活率显著更高。
