Center for Colon and Rectal Surgery, Surgical Health Outcomes Consortium (SHOC), Florida Hospital, Orlando, FL.
Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
Ann Surg. 2019 Dec;270(6):1110-1116. doi: 10.1097/SLA.0000000000002862.
To compare the quality of surgical resection of transanal total mesorectal excision (TA-TME) and robotic total mesorectal excision (R-TME).
Both TA-TME and R-TME have been advocated to improve the quality of surgery for rectal cancer below 10 cm from the anal verge, but there are little data comparing TA-TME and R-TME.
Data of patients undergoing TA-TME or R-TME for rectal cancer below 10 cm from the anal verge and a sphincter-saving procedure from 5 high-volume rectal cancer referral centers between 2011 and 2017 were obtained. Coarsened exact matching was used to create balanced cohorts of TA-TME and R-TME. The main outcome was the incidence of poor-quality surgical resection, defined as a composite measure including incomplete quality of TME, or positive circumferential resection margin (CRM) or distal resection margin (DRM).
Out of a total of 730 patients (277 TA-TME, 453 R-TME), matched groups of 226 TA-TME and 370 R-TME patients were created. These groups were well-balanced. The mean tumor height from the anal verge was 5.6 cm (SD 2.5), and 70% received preoperative radiotherapy. The incidence of poor-quality resection was similar in both groups (TA-TME 6.9% vs R-TME 6.8%; P = 0.954). There were no differences in TME specimen quality (complete or near-complete TA-TME 99.1% vs R-TME 99.2%; P = 0.923) and CRM (5.6% vs 6.0%; P = 0.839). DRM involvement may be higher after TA-TME (1.8% vs 0.3%; P = 0.051).
High-quality TME for patients with rectal adenocarcinoma of the mid and low rectum can be equally achieved by transanal or robotic approaches in skilled hands, but attention should be paid to the distal margin.
比较经肛门全直肠系膜切除术（TA-TME）和机器人全直肠系膜切除术（R-TME）的手术切除质量。
TA-TME 和 R-TME 均被提倡用于提高距肛缘 10cm 以内直肠癌的手术质量，但比较 TA-TME 和 R-TME 的数据很少。
获取了 2011 年至 2017 年间，来自 5 个高容量直肠癌转诊中心的接受 TA-TME 或 R-TME 治疗且保肛的距肛缘 10cm 以内直肠癌患者的数据。使用粗化精确匹配创建 TA-TME 和 R-TME 的平衡队列。主要结局是不良手术切除质量的发生率，定义为包括 TME 质量不完整、环周切缘阳性（CRM）或远端切缘阳性（DRM）的复合指标。
共纳入 730 例患者（TA-TME 277 例，R-TME 453 例），创建了 226 例 TA-TME 和 370 例 R-TME 患者的匹配组。这些组之间的平衡良好。距肛缘的平均肿瘤高度为 5.6cm（标准差 2.5），70%的患者接受了术前放疗。两组不良切除质量的发生率相似（TA-TME 6.9% vs R-TME 6.8%；P=0.954）。TME 标本质量（完整或接近完整的 TA-TME 99.1% vs R-TME 99.2%；P=0.923）和 CRM（5.6% vs 6.0%；P=0.839）无差异。TA-TME 后 DRM 受累可能更高（1.8% vs 0.3%；P=0.051）。
在熟练的术者手中，经肛门或机器人方法均可为中低位直肠腺癌患者实现高质量的 TME，但应注意远端切缘。
