Department of Surgery, Slagelse Hospital, Faelledvej 11, 4200, Slagelse, Denmark.
University of Copenhagen, Copenhagen, Denmark.
Surg Endosc. 2018 May;32(5):2312-2321. doi: 10.1007/s00464-017-5926-x. Epub 2017 Nov 2.
To compare short-term results of total mesorectal excision (TME) for mid and low rectal cancer, achieved by transanal (TaTME), laparoscopic (LaTME), and open (OpTME) approaches.
The impact of TaTME on the surgical treatment of mid and low rectal cancer has yet to be clarified.
This is a case-matched study, based on data from a prospectively maintained database of patients who underwent TaTME from May 2015 to March 2017, and a retrospective chart review of patients who underwent LaTME and OpTME in the previous period. Each patient in the TaTME group was matched to one LaTME and one OpTME based on sex, BMI, tumor status, and the height of the tumor from the anal verge. Primary end-points were rates of positive circumferential resection margin (CRM), distal resection margin, and the macroscopic quality of the surgical specimen. Composite of these outcomes was compared as an indication for successful surgery. Secondary end-points included intraoperative data and postoperative course and complications.
Three hundred patients were included (TaTME = 100, LaTME = 100, OpTME = 100). The three groups were comparable in the baseline characteristics. TaTME resulted in lower rates of incomplete TME specimens than LaTME, but not OpTME (P = 0.016, P = 0.750, respectively). The rates of CRM involvement, mean CRM distance, and the percentages of successful surgery were comparable among the three groups (P = 0.368). The conversion to open surgery occurred only in the LaTME group. TaTME resulted in shorter operation time and less blood loss than the other two groups (P < 0.001 and P < 0.001). Hospital stay was shorter in the TaTME group (P = 0.002); complication rate and mortality were comparable among the groups.
TaTME had, in our hands, some obvious benefits over other approaches. The pathological results were not significantly superior to LaTME and OpTME. The procedure is however feasible and safe. Further studies are needed to evaluate the long-term oncological and quality of life outcomes.
比较经肛门全直肠系膜切除术（TaTME）、腹腔镜全直肠系膜切除术（LaTME）和开腹全直肠系膜切除术（OpTME）治疗中低位直肠癌的短期疗效。
TaTME 对中低位直肠癌治疗的影响仍需阐明。
这是一项病例匹配研究，基于 2015 年 5 月至 2017 年 3 月期间接受 TaTME 治疗的患者前瞻性维护数据库的数据，以及同期接受 LaTME 和 OpTME 治疗的患者的回顾性图表审查。TaTME 组的每位患者均根据性别、BMI、肿瘤状态和肿瘤距肛缘的高度与一位 LaTME 患者和一位 OpTME 患者相匹配。主要终点是阳性环周切缘（CRM）、远端切缘和手术标本的宏观质量的比例。这些结果的组合作为手术成功的指标进行比较。次要终点包括术中数据和术后过程及并发症。
共纳入 300 例患者（TaTME=100 例，LaTME=100 例，OpTME=100 例）。三组患者的基线特征相似。与 LaTME 相比，TaTME 导致不完全 TME 标本的比例较低，但与 OpTME 相比则不然（分别为 P=0.016，P=0.750）。三组之间 CRM 受累率、平均 CRM 距离和手术成功率的比例相似（P=0.368）。仅在 LaTME 组中转开腹手术。TaTME 组的手术时间和出血量均短于其他两组（P<0.001 和 P<0.001）。TaTME 组的住院时间较短（P=0.002）；三组的并发症发生率和死亡率相似。
在我们手中，TaTME 相对于其他方法有一些明显的优势。病理结果并不明显优于 LaTME 和 OpTME。但是该操作是可行且安全的。需要进一步的研究来评估长期的肿瘤学和生活质量结果。
