Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
Colorectal Dis. 2017 Dec;19(12):1100-1107. doi: 10.1111/codi.13768.
After endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgey (TEM) the N parameter may remain undefined. Nucleotide-guided mesorectal excision (NGME) improves the lymph node harvest. The aim of the present study is to evaluate the long-term oncological results after ELRR with NGME.
A total of 57 patients were enrolled over the period January 2001 to June 2015. All patients underwent ELRR by TEM. Prior to surgery, 99 m-technetium-marked nanocolloid was injected into the peritumoural submucosa. After removal of the specimen, the residual defect was probed to detect any residual radioactivity and 'hot' mesorectal fat was excised. All patients were included in a 5-year follow-up programme.
Significant radioactivity in the residual cavity was found in 28 out of 57 patients (49%). The mean number of lymph nodes harvest in irradiated and nonirradiated patients was 1.66 and 2.76, respectively. After 68.2 months' follow-up overall survival was 91.2%, disease-related mortality 3.5% and disease-free survival 89.5%. Two patients developed pulmonary metastases: one ypT3N0 patient underwent lung lobectomy after chemotherapy and one pT2N0 patient was managed with lung radiotherapy. Both patients are currently alive and disease-free at 48 months' follow-up. Two patients developed local recurrence 1 year after ELRR, both treated with neoadjuvant chemo-radiotherapy and total mesorectal excision. Comparing the present series with previous patients who did not undergo NGME, an increased number of harvested lymph nodes were observed, with a statistically significant difference (P = 0.0085).
NGME during ELRR improves the lymph node harvest and staging accuracy. The long-term results showed satisfactory local (3.5%) and distant (7%) recurrence rates.
经肛门内镜微创手术（TEM）腔内局部切除术（ELRR）后，N 分期可能仍无法明确。核苷酸引导的中低位直肠系膜切除术（NGME）可提高淋巴结清扫数量。本研究旨在评估 ELRR 后采用 NGME 的长期肿瘤学结果。
2001 年 1 月至 2015 年 6 月期间共纳入 57 例患者。所有患者均行经 TEM 行 ELRR。手术前，将 99m 锝标记的纳米胶体注入肿瘤周围黏膜下层。切除标本后，探测残腔以检测任何残留放射性，并切除“热”中低位直肠系膜脂肪。所有患者均纳入 5 年随访计划。
57 例患者中，28 例（49%）残腔有明显放射性。照射组和非照射组的平均淋巴结清扫数量分别为 1.66 个和 2.76 个。68.2 个月随访后，总生存率为 91.2%，疾病相关死亡率为 3.5%，无病生存率为 89.5%。2 例患者发生肺转移：1 例 ypT3N0 患者在化疗后行肺叶切除术，1 例 pT2N0 患者行肺放疗。2 例患者目前均无病生存，随访 48 个月。2 例患者在 ELRR 后 1 年发生局部复发，均行新辅助放化疗和全直肠系膜切除术。与未行 NGME 的既往患者相比，本研究中观察到淋巴结清扫数量增加，差异有统计学意义（P=0.0085）。
ELRR 时行 NGME 可提高淋巴结清扫数量和分期准确性。长期结果显示局部（3.5%）和远处（7%）复发率均令人满意。
