Lee Lawrence, Edwards Kimberly, Hunter Iain A, Hartley John E, Atallah Sam B, Albert Matthew R, Hill James, Monson John R
1 Center for Colon and Rectal Surgery, Florida Hospital, Orlando, Florida 2 Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom 3 Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Dis Colon Rectum. 2017 Sep;60(9):928-935. doi: 10.1097/DCR.0000000000000884.
There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery.
The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery.
This was a multi-institutional cohort study using coarsened exact matching.
The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons.
Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included.
Transanal endoscopic microsurgery and transanal minimally invasive surgery were the included interventions.
The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured.
The matched cohort consisted of 428 patients (247 with transanal endoscopic microsurgery and 181 with transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing transanal endoscopic microsurgery was 80% compared with 78% for patients undergoing transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for transanal endoscopic microsurgery and 7% (7/94) for transanal minimally invasive surgery (p = 0.864).
All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods.
High-quality local excision for benign and rectal neoplasms can be equally achieved using transanal endoscopic microsurgery or transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
目前尚无关于经肛门内镜显微手术和经肛门微创手术切除直肠肿瘤的质量比较数据。
本研究旨在比较经肛门内镜显微手术与经肛门微创手术对良性和恶性直肠肿瘤患者进行局部切除时肿瘤破碎和切缘阳性的发生率。
这是一项使用粗化精确匹配的多机构队列研究。
该研究在拥有结直肠外科专家的大型三级医疗机构进行。
纳入接受良性和恶性直肠肿瘤全层局部切除的患者。
经肛门内镜显微手术和经肛门微创手术为纳入的干预措施。
测量切除质量差的发生率（包括肿瘤破碎和/或切缘阳性的综合指标）。
匹配队列包括428例患者（247例行经肛门内镜显微手术，181例行经肛门微创手术）。经肛门微创手术与手术时间缩短和住院时间缩短相关。切除质量差的情况相似（8%对11%；p = 0.233）。腹膜侵犯（3%对3%；p = 0.965）和术后并发症（11%对9%；p = 0.477）也无差异。经肛门内镜显微手术患者的5年累积无病生存率为80%，经肛门微创手术患者为78%（对数秩检验p = 0.824）。未立即接受挽救性手术的恶性肿瘤患者的局部复发率，经肛门内镜显微手术为7%（8/117），经肛门微创手术为7%（7/94）（p = 0.864）。
所有手术均由结直肠外科专家在大型转诊中心进行，围手术期操作略有不同，且时间不同。
经肛门内镜显微手术或经肛门微创手术均可同样实现对良性和直肠肿瘤的高质量局部切除。直肠肿瘤局部切除手术平台的选择应基于外科医生的偏好、可用性和成本。见视频摘要：http://links.lww.com/DCR/A382 。
