Colorectal Surgical Associates LLP, LTD, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX.
Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX.
J Am Coll Surg. 2016 May;222(5):814-22. doi: 10.1016/j.jamcollsurg.2016.02.003. Epub 2016 Feb 13.
Transanal minimally invasive surgery (TAMIS) is an advanced local excision platform that helps overcome technical limitations and morbidity associated with other resection methods. Our goal was to review the indications and outcomes of TAMIS in a large series.
A review of a prospective database identified patients who underwent TAMIS from 2010 to 2014. Demographic, perioperative, short-term outcomes, and recurrence data were analyzed.
There were 75 patients with 76 lesions analyzed. Mean age was 64.0 years (SD 11.6 years) and mean BMI was 27.4 kg/m(2) (SD 4.7 kg/m(2)). Median American Society of Anesthesiologists (ASA) score was 2 (range 1 to 4). There were 59 benign (77.3%) and 17 malignant (22.7%) lesions: 6 pT0, 6 pT1, 4 pT2, and 1 pT3. Median lesion distance from the anal verge was 10 cm (range 6 to 16 cm). Mean operative time was 76.0 minutes (SD 36.1 minutes). Three patients had intraperitoneal entry; all were closed transanally, but 2 had temporary diverting ileostomies fashioned to ensure healing. Median length of stay was 1 day (range 0 to 6). One patient had a fragmented lesion (1.3%). Five patients had positive margins: 2 in palliative pT2 resections, and 3 in pT1, pT2, and gastrointestinal stromal tumor (GIST) patients. They were managed with radical resection (pT1 and pT2 lesions) and surveillance/medical oncology (GIST). Postoperatively, 3 patients had complications (bleeding, rectal stricture, and recto-vaginal fistula), and all were managed nonoperatively. After median follow-up of 39.5 months (range 10.5 to 65.3 months), 1 pT1 patient with negative margins developed a local recurrence and underwent salvage APR.
Transanal minimally invasive surgery is a viable option for excision of benign or early stage rectal masses, with mid-term oncologic outcomes comparable to those of radical resection. Further, TAMIS minimizes the morbidity and can allow more patients to benefit from the minimally invasive approach.
经肛门微创手术（TAMIS）是一种先进的局部切除平台，有助于克服与其他切除方法相关的技术限制和发病率。我们的目标是在一个大型系列中回顾 TAMIS 的适应证和结果。
对前瞻性数据库的回顾确定了 2010 年至 2014 年间接受 TAMIS 治疗的患者。分析了人口统计学、围手术期、短期结果和复发数据。
75 例患者，76 处病变。平均年龄为 64.0 岁（标准差 11.6 岁），平均 BMI 为 27.4kg/m2（标准差 4.7kg/m2）。中位美国麻醉医师协会（ASA）评分 2 分（1 至 4 分）。良性病变 59 例（77.3%），恶性病变 17 例（22.7%）：6 例 pT0，6 例 pT1，4 例 pT2，1 例 pT3。病变距肛门缘的中位距离为 10cm（6 至 16cm）。平均手术时间为 76.0 分钟（标准差 36.1 分钟）。3 例患者有腹腔内进入；所有患者均经肛门闭合，但 2 例有暂时性回肠造口术以确保愈合。中位住院时间为 1 天（0 至 6 天）。1 例患者有碎片（1.3%）。5 例患者切缘阳性：2 例姑息性 pT2 切除术，3 例 pT1、pT2 和胃肠道间质瘤（GIST）患者。他们接受了根治性切除术（pT1 和 pT2 病变）和随访/肿瘤内科治疗（GIST）。术后，3 例患者出现并发症（出血、直肠狭窄和直肠阴道瘘），均经非手术治疗。中位随访 39.5 个月（10.5 至 65.3 个月）后，1 例 pT1 患者切缘阴性，局部复发，行挽救性腹会阴联合切除术。
经肛门微创手术是切除良性或早期直肠肿块的可行选择，其中期肿瘤学结果与根治性切除术相当。此外，TAMIS 最大限度地减少了发病率，并使更多的患者受益于微创方法。
