Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
Surg Endosc. 2019 Jan;33(1):94-102. doi: 10.1007/s00464-018-6279-9. Epub 2018 Jul 2.
The standard treatment for mid- and low-rectal cancer is total mesorectal excision. Incomplete excision is an important predictor of local recurrence after rectal cancer surgery. Transanal TME (TaTME) is a new treatment option in which the rectum is approached with both laparoscopic and transanal endoscopic techniques. The aim of the present study was to determine the prevalence and localisation of residual mesorectal tissue by postoperative magnetic resonance imaging (MRI) of the pelvis and compare this between TaTME and laparoscopic TME (LapTME) patients. In addition, we assessed correspondence with histopathological quality.
Two groups of patients with cT1-T3 rectal cancer who underwent TME surgery with primary anastomosis were included, each group consisting of 32 patients. Postoperative T2-weighted MRI of the pelvis was performed at least 6 months after TME surgery and evaluated by two radiologists independently. Residual mesorectum was defined as any residual mesorectal tissue detectable after TME. Localisation of the tissue was categorised in relation to height in the pelvis and position of the level of anastomosis.
Residual mesorectal tissue was detected in 3.1% of TaTME patients and of 46.9% in LapTME patients (p < 0.001). Multivariate analysis identified only type of surgery as a significant risk factor for leaving residual mesorectum. Other known risk factors for incomplete TME, such as body mass index (BMI) and male gender, were not significant. No relation was seen between specimen quality and prevalence of residual mesorectum.
The completeness of mesorectal excision was significantly better with TaTME than with standard laparoscopic technique.
中低位直肠肿瘤的标准治疗方法是全直肠系膜切除术。直肠癌手术后局部复发的一个重要预测因素是切除不完整。经肛门全直肠系膜切除术（TaTME）是一种新的治疗选择，它采用腹腔镜和经肛门内镜技术来接近直肠。本研究的目的是通过术后骨盆磁共振成像（MRI）确定残留直肠系膜组织的发生率和定位，并将其与 TaTME 和腹腔镜全直肠系膜切除术（LapTME）患者进行比较。此外，我们还评估了与组织病理学质量的一致性。
纳入了两组接受 TME 手术加原发性吻合术的 cT1-T3 直肠肿瘤患者，每组 32 例。TME 手术后至少 6 个月进行盆腔 T2 加权 MRI，由两位放射科医生独立评估。残留直肠系膜定义为 TME 后可检测到的任何残留直肠系膜组织。组织的定位与骨盆的高度和吻合口的位置有关。
TaTME 患者中残留直肠系膜组织的检出率为 3.1%，LapTME 患者中为 46.9%（p<0.001）。多因素分析仅发现手术类型是残留直肠系膜的一个显著危险因素。其他已知的 TME 不完整的危险因素，如体重指数（BMI）和男性性别，没有显著意义。标本质量与残留直肠系膜的发生率之间没有关系。
TaTME 比标准腹腔镜技术的直肠系膜切除完整性要好。
