Fenig Yaniv, Khoury Mansour, Schmilovitz-Weiss Hemda, Gingold-Belfer Rachel, Nissim Bachar Gil, Issa Nidal
Department of Surgery Monmouth Medical Center, Long Branch, New Jersey, USA.
Department of Surgery.
Eur J Gastroenterol Hepatol. 2018 Jan;30(1):113-117. doi: 10.1097/MEG.0000000000001000.
The prevalence of obesity is as high as one-third of the adult population in the ultrasound. Obese patients operated for rectal cancer are less likely to undergo sphincter-preserving surgery, and have an increased morbidity and mortality. We aim to report the outcomes of transanal-endoscopic-microsurgery (TEM) in obese patients with benign and malignant neoplasms.
An analysis was carried out of all patients undergoing TEM at a single institution between 2004 and 2015. Clinical, demographic, and pathologic data were analyzed in respect to BMI; a dichotomous variable was created categorizing the patients in this retrospective case series as either obese (BMI≥30) or nonobese (BMI<30).
Of the 158 patients who underwent TEM during the study period, 51 (32%) were obese and 107 (68%) were nonobese. No significant differences were found in terms of patients' demographics and tumor characteristics. There were no significant differences in operative time [105 min (range: 75-170) and 98 (range: 56-170), respectively, P=0.2], hospital length of stay [3 days (range: 2-6) and 4 (range: 2-12), respectively, P=0.48], or complication rates (20 and 23%, respectively, P=0.68).
TEM is a safe procedure for rectal neoplasms in the obese population. We found no difference in surgical time and completeness of specimen resection, and no increase in complications or length of stay in the hospital in obese versus nonobese patients. As for selected high risk patients, the TEM may be of benefit in obese patients with T1/T2N0M0 rectal cancer.
在超声检查中，肥胖症的患病率高达成年人口的三分之一。接受直肠癌手术的肥胖患者进行保肛手术的可能性较小，且发病率和死亡率增加。我们旨在报告经肛门内镜显微手术（TEM）治疗肥胖患者良性和恶性肿瘤的结果。
对2004年至2015年间在单一机构接受TEM治疗的所有患者进行分析。分析了患者的临床、人口统计学和病理数据与体重指数（BMI）的关系；在这个回顾性病例系列中，将患者分为肥胖（BMI≥30）或非肥胖（BMI<30）两类，创建了一个二分变量。
在研究期间接受TEM治疗的158例患者中，51例（32%）为肥胖患者，107例（68%）为非肥胖患者。在患者的人口统计学和肿瘤特征方面未发现显著差异。手术时间[分别为105分钟（范围：75 - 170分钟）和98分钟（范围：56 - 170分钟），P = 0.2]、住院时间[分别为3天（范围：2 - 6天）和4天（范围：2 - 12天），P = 0.48]或并发症发生率（分别为20%和23%，P = 0.68）方面均无显著差异。
TEM对于肥胖人群的直肠肿瘤是一种安全的手术方法。我们发现肥胖患者与非肥胖患者在手术时间和标本切除完整性方面没有差异，并发症或住院时间也没有增加。对于选定的高风险患者，TEM可能对T1/T2N0M0期直肠癌肥胖患者有益。
