Maykel Justin A, Phatak Uma R, Suwanabol Pasithorn A, Schlussel Andrew T, Davids Jennifer S, Sturrock Paul R, Alavi Karim
1 Department of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 2 Department of Surgery, University of Michigan, Ann, Arbor, Michigan 3 Department of Surgery, Madigan Army Medical Center, Tacoma, Washington.
Dis Colon Rectum. 2017 Dec;60(12):1267-1272. doi: 10.1097/DCR.0000000000000921.
Short-term results have shown that transanal total mesorectal excision is safe and effective for patients with mid to low rectal cancers. Transanal total mesorectal excision is considered technically challenging; thus, adoption has been limited to a few academic centers in the United States.
The aim of this study is to describe outcomes after the initiation of a transanal total mesorectal excision program in the setting of an academic colorectal training program.
This is a single-center retrospective review of consecutive patients who underwent transanal total mesorectal excision from December 2014 to August 2016.
This study was conducted at an academic center with a colorectal residency program.
Patients with benign and malignant diseases were selected.
All transanal total mesorectal excisions were performed with abdominal and perineal teams working simultaneously.
The primary outcomes measured were pathologic quality, length of hospital stay, 30-day morbidity, and 30-day mortality.
There were 40 patients (24 male). The median age was 55 years (interquartile range, 46.7-63.4) with a median BMI of 29 kg/m (interquartile range, 24.6-32.4). The primary indication was cancer (n = 30), and tumor height from the anal verge ranged from 0.5 to 15 cm. Eighty percent (n = 24) of the patients who had rectal cancer received preoperative chemoradiation. The most common procedures were low anterior resection (67.5%), total proctocolectomy (15%), and abdominoperineal resection (12.5%). Median operative time was 380 minutes (interquartile range, 306-454.4), with no change over time. For patients with malignancy, the mesorectum was complete or nearly complete in 100% of the specimens. A median of 14 lymph nodes (interquartile range, 12-17) were harvested, and 100% of the rectal cancer specimens achieved R0 status. Median length of stay was 4.5 days (interquartile range, 4-7), and there were 6 readmissions (15%). There were no deaths or intraoperative complications.
This study's limitations derive from its retrospective nature and single-center location.
A transanal total mesorectal excision program can be safely implemented in a major academic medical center. Quality outcomes and patient safety depend on a comprehensive training program and a coordinated team approach. See Video Abstract at http://links.lww.com/DCR/A448.
短期结果表明，经肛门全直肠系膜切除术对中低位直肠癌患者安全有效。经肛门全直肠系膜切除术在技术上具有挑战性；因此，该手术仅在美国少数学术中心开展。
本研究旨在描述在学术性结直肠培训项目中开展经肛门全直肠系膜切除术后的结果。
这是一项对2014年12月至2016年8月期间连续接受经肛门全直肠系膜切除术患者的单中心回顾性研究。
本研究在一个设有结直肠住院医师培训项目的学术中心进行。
选择患有良性和恶性疾病的患者。
所有经肛门全直肠系膜切除术均由腹部和会阴团队同时进行。
主要观察指标为病理质量、住院时间、30天发病率和30天死亡率。
共40例患者（24例男性）。中位年龄为55岁（四分位间距为46.7 - 63.4岁），中位体重指数为29kg/m²（四分位间距为24.6 - 32.4）。主要适应证为癌症（n = 30），肿瘤距肛缘高度为0.5至15cm。80%（n = 24）的直肠癌患者接受了术前放化疗。最常见的手术方式为低位前切除术（67.5%）、全直肠结肠切除术（15%）和腹会阴联合切除术（12.5%）。中位手术时间为380分钟（四分位间距为306 - 454.4分钟），且未随时间变化。对于恶性肿瘤患者，100%的标本直肠系膜完整或近乎完整。中位清扫淋巴结数为14枚（四分位间距为12 - 17枚），100%的直肠癌标本达到R0切除状态。中位住院时间为4.5天（四分位间距为4 - 7天），6例患者再次入院（15%）。无死亡病例或术中并发症。
本研究的局限性源于其回顾性研究性质和单中心设置。
经肛门全直肠系膜切除项目可在大型学术医学中心安全实施。良好的结果和患者安全取决于全面的培训项目和团队协作方法。见视频摘要：http://links.lww.com/DCR/A448 。
