Marks J H, Montenegro G A, Salem J F, Shields M V, Marks G J
Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
Division of Colorectal Surgery, Saint Louis University Hospital, Saint Louis, MO, USA.
Tech Coloproctol. 2016 Jul;20(7):467-73. doi: 10.1007/s10151-016-1482-y. Epub 2016 May 13.
Natural orifice translumenal endoscopic surgery (NOTES) has always made more sense in the colorectal field where the target organ for entry houses the pathology. To address the question whether an adequate total mesorectal excision (TME) for rectal cancer can be performed from a transanal bottoms-up approach, we performed a case-matched study.
Starting in 2009, transanal TME (taTME) surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database. Between March 2012 and February 2014, 17 consecutive taTME rectal cancer patients were identified and case-matched to multiport laparoscopic TME (MP TME) based on age, body mass index, uT stage, radiation dose, level in the rectum, and procedure. Perioperative outcomes, morbidity, mortality, local recurrence, completeness of TME, and radial and distal margins were analyzed. Statistically significant differences were identified using Student's t test.
There were 12 transanal abdominal transanal (TATA)/5 abdominoperineal resection procedures in each group. Data regarding overall/taTME/MP TME are as follows: % positive-circumferential margin: 2.9/0/5.9 % (p = 0.32). Distal margin: 0/0/0 %. Complete or near-complete TME: 97.1/100/94.1 % (p = 0.32). Incomplete TME 2.9/0/5.9 % (p = 0.32). Local recurrence: 2.9/5.9/0 % (p = 0.32). There were no perioperative mortalities. Morbidity in each group: 26.4/23.5/29.4 % (p = 0.79). There were no differences in perioperative or postoperative outcomes except days to clear liquids (1/2 days, p = 0.03) and largest incision length (1.3/2.6 cm, p = 0.05).
We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottoms-up TME compared to standard laparoscopic TME. TaTME is a promising progressive approach to NOTES and deserves additional evaluation.
自然腔道内镜手术（NOTES）在结直肠领域一直更具意义，因为进入的目标器官容纳病变。为了探讨经肛门自下而上的方法能否对直肠癌进行充分的全直肠系膜切除术（TME），我们进行了一项病例匹配研究。
从2009年开始，选择性地将经肛门TME（taTME）手术用于新辅助治疗后的直肠癌，并前瞻性地录入数据库。在2012年3月至2014年2月期间，确定了17例连续的taTME直肠癌患者，并根据年龄、体重指数、uT分期、放疗剂量、直肠位置和手术方式与多端口腹腔镜TME（MP TME）进行病例匹配。分析围手术期结局、发病率、死亡率、局部复发、TME的完整性以及切缘和远切缘情况。使用学生t检验确定统计学上的显著差异。
每组有12例经肛门经腹经肛门（TATA）/5例腹会阴联合切除术。总体/taTME/MP TME的数据如下：环周切缘阳性率：2.9%/0/5.9%（p = 0.32）。远切缘：0/0/0%。完整或近乎完整的TME：97.1%/100%/94.1%（p = 0.32）。不完整的TME：2.9%/0/5.9%（p = 0.32）。局部复发：2.9%/5.9%/0%（p = 0.32）。无围手术期死亡。每组的发病率：26.4%/23.5%/29.4%（p = 0.79）。除了进清流食天数（1/2天，p = 0.03）和最大切口长度（1.3/2.6 cm，p = 0.05）外，围手术期或术后结局无差异。
我们证明，与标准腹腔镜TME相比，经肛门或自下而上的TME在围手术期/术后结局或病理TME结局方面无差异。TaTME是NOTES一种有前景的进步方法，值得进一步评估。
