Deborah S Keller, Scott R Steele
Division of Colon and Rectal Surgery, Columbia University Medical Center, New York-Presbyterian, NY 10032, USA.
Department of Colorectal Surgery, Cleveland Clinic, OH 44195, USA.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Mar 25;21(3):250-258.
Colorectal cancer is the 3rd most commonly diagnosed cancer, with rectal cancer specifically accounting for 1/3 of new cases. Despite advances in care, there is still a lack of standardization in diagnosis, staging, and treatment, with associated high rates of positive margins, recurrence, and mortality. The gold standard for curative resection remains a total mesorectal excision(TME), and the quality of the TME is one of the most important prognostic factors for local recurrence. The proper TME specimen with negative resection margins is inherently challenging due to patient and tumour-related factors. These difficulties have not been overcome with the laparoscopic approach. Transanal TME (taTME) is an innovative surgical technique developed to overcome the limitations in exposure and instrumentation in low pelvic surgery by approaching the rectum from below. Interest in taTME continues to grow worldwide, and structured training programs and case registries have been developed to aid safe implementation of this new technique in clinical practice. As the utilization of taTME and indications for the procedure continue to expand, structured programs to standardize teaching, training, and safe expansion will aid the safe spread of the taTME technique. With the growing popularity, a review of the pros and cons of the taTME is timely.
结直肠癌是第三大常见诊断癌症，其中直肠癌占新发病例的三分之一。尽管在治疗方面取得了进展，但在诊断、分期和治疗上仍缺乏标准化，伴有切缘阳性、复发和死亡率的高发生率。根治性切除的金标准仍然是全直肠系膜切除术（TME），TME的质量是局部复发最重要的预后因素之一。由于患者和肿瘤相关因素，获得切缘阴性的合适TME标本本身具有挑战性。腹腔镜手术方法尚未克服这些困难。经肛全直肠系膜切除术（taTME）是一种创新的手术技术，通过从下方接近直肠来克服低位盆腔手术中暴露和器械操作方面的局限性。全球范围内对taTME的兴趣持续增长，并且已经制定了结构化培训计划和病例登记系统，以帮助在临床实践中安全实施这项新技术。随着taTME的应用和该手术适应证的不断扩大，规范教学、培训和安全推广的结构化计划将有助于taTME技术的安全推广。随着其日益普及，对taTME的利弊进行综述恰逢其时。
