Oh Jae Hwan, Park Sung Chan, Kim Min Jung, Park Byung Kwan, Hyun Jong Hee, Chang Hee Jin, Han Kyung Su, Sohn Dae Kyung
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Ann Surg Treat Res. 2016 Oct;91(4):187-194. doi: 10.4174/astr.2016.91.4.187. Epub 2016 Sep 30.
To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer.
This study enrolled 12 patients with clinically node negative rectal cancer located 4-12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027).
The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/m. Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1.
This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications.
评估经肛门全直肠系膜切除术（TME）在直肠癌患者中的可行性。
本研究纳入了12例临床分期淋巴结阴性的直肠癌患者，肿瘤距肛缘4 - 12 cm，于2013年9月至2014年8月在单孔腹腔镜手术辅助下接受经肛门内镜TME手术。主要终点是TME质量；次要终点包括清扫淋巴结数量和30天内术后并发症（NCT01938027）。
12例患者中，男性7例，女性5例，中位年龄59岁，中位体重指数24.2 kg/m²。肿瘤平均距肛缘6.7 cm。4例患者（33.3%）接受了术前放化疗。中位手术时间为195分钟，中位失血量为50 mL。无术中并发症，无中转开腹手术。11例患者（91.7%）的TME完整或接近完整。中位远端切缘和环周切缘分别为18.5 mm和10 mm。中位清扫淋巴结数量为15枚。中位住院时间为9天。无术后死亡病例。6例患者出现轻微术后并发症，包括2例排尿功能障碍、3例短暂性肠梗阻和1例伤口脓肿。
这项前瞻性研究表明，大多数患者可以进行高质量的TME且无严重并发症。经肛门TME治疗直肠癌患者可能是可行且安全的，但需要进一步研究以评估其长期功能和肿瘤学结局，并明确其适应证。
