Haugvik Sven-Petter, Groven Sigrid, Bondi Johan, Vågan Torolf, Brynhildsvoll Stig Ove, Olsen Ole Christian
a Department of Surgery , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway ;
b Department of Pathology , Drammen Hospital, Vestre Viken Hospital Trust , Drammen , Norway.
Scand J Gastroenterol. 2016 Jul;51(7):855-9. doi: 10.3109/00365521.2016.1157891. Epub 2016 Mar 22.
The aim of this study was to describe feasibility, postoperative morbidity, and histological outcome of transanal minimally-invasive surgery (TAMIS) in patients with rectal adenoma.
All patients who underwent TAMIS at a single institution from December 2011 to December 2015 were retrospectively included in the study. Feasibility was based on tumor size, distance of tumor from the anal verge, operative time, and hospital stay. Thirty-day morbidity was defined by the revised Accordion Classification system. Histological outcome included microscopic resection margin status, specimen fragmentation status, and grading of dysplasia in rectal adenoma.
A total of 51 patients with rectal adenoma underwent TAMIS. The median tumor diameter was 32 (4-60) mm and the median distance from the anal verge 8 (3-14) cm. Median operative time was 40 (13-116) min and median length of hospital stay was 1 (0-25) days. Overall morbidity was 12% (four grade 1, one grade 2, and one grade 3 complications). 22% had a positive resection margin, whereas 31% had an indefinable resection margin status mostly due to tissue fragmentation. Median follow-up time was 7 (0-40) months.
TAMIS is a challenging surgical technique for treatment of rectal adenoma. Our initial experience among 51 patients resulted in a high proportion of positive resection margins and a high fragmentation rate. The role of TAMIS in the treatment of rectal adenoma is to be defined through comparative studies.
本研究旨在描述经肛门微创手术（TAMIS）治疗直肠腺瘤患者的可行性、术后发病率及组织学结果。
回顾性纳入2011年12月至2015年12月在单一机构接受TAMIS治疗的所有患者。可行性基于肿瘤大小、肿瘤距肛缘距离、手术时间及住院时间。采用修订的手风琴分类系统定义30天发病率。组织学结果包括显微镜下切缘状态、标本破碎状态及直肠腺瘤发育异常分级。
共有51例直肠腺瘤患者接受了TAMIS治疗。肿瘤中位直径为32（4 - 60）mm，距肛缘中位距离为8（3 - 14）cm。中位手术时间为40（13 - 116）分钟，中位住院时间为1（0 - 25）天。总体发病率为12%（4例1级、1例2级和1例3级并发症）。22%的患者切缘阳性，而31%的患者切缘状态难以确定，主要原因是组织破碎。中位随访时间为7（0 - 40）个月。
TAMIS是一种具有挑战性的直肠腺瘤治疗手术技术。我们对51例患者的初步经验显示，切缘阳性比例高且破碎率高。TAMIS在直肠腺瘤治疗中的作用有待通过比较研究来确定。
