Dulskas Audrius, Kilius Alfredas, Petrulis Kestutis, Samalavicius Narimantas E
Centre of Oncosurgery, National Cancer Institute, Vilnius, Lithuania.
Centre of Oncosurgery, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius, Lithuania.
Ann Coloproctol. 2017 Feb;33(1):23-27. doi: 10.3393/ac.2017.33.1.23. Epub 2017 Feb 28.
The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM).
Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences.
The average tumor size was 2.8 ± 1.5 cm (range, 0.5-8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days.
TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.
本研究旨在观察经肛门内镜显微手术（TEM）治疗良性及早期恶性直肠肿瘤患者的并发症发生率、复发率以及进一步行根治性手术的必要性。
我们的研究纳入了2009年12月至2015年12月在立陶宛国家癌症研究所外科肿瘤学部门接受TEM治疗直肠腺瘤和早期直肠癌的130例患者。患者接受了指诊和内镜评估，并进行了多次活检。术前行盆腔磁共振成像或直肠内超声检查以进行术前分期。我们记录了患者的人口统计学资料、手术细节、最终病理结果、术后住院时间、术后并发症及复发情况。
肿瘤平均大小为2.8±1.5cm（范围0.5 - 8.3cm）。共切除102例良性肿瘤（78.5%）和28例恶性肿瘤（21.5%）。后者中，23例（82.1%）为pT1期癌，5例（17.9%）为pT2期癌。5例pT2期癌患者中，2例接受了辅助放化疗，1例接受了腹会阴联合切除术，1例拒绝进一步治疗，1例失访。术中无并发症发生。7例患者（5.4%）出现术后并发症：尿潴留（4例，3.1%）、术后出血（2例，1.5%）和伤口裂开（1例，0.8%）。所有并发症均经保守治疗。术后平均住院时间为2.3天。
根据我们的经验，TEM显示出较低的并发症和复发率。该技术推荐用于治疗直肠腺瘤和早期直肠癌患者，预后良好。
