Wu Aiwen, He Guoli, Wang Lin, Dong Qiushi, Liu Xinzhi, Li Yingjie, Leng Jiahua, Zhang Xiao, Sun Tingting, Zhang Yue, Yao Yunfeng
Ward 3, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jun 25;21(6):646-653.
To explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations.
Clinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria: (1) low rectal cancer, the distance between inferior margin of tumor and anal verge ≤5 cm; (2) the distance between two sciatic tubercles <5 cm; (3) body mass index (BMI) >25 kg/m; (4) tumor horizontal diameter ≤4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed.
A total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7(26.2-36.4) kg/m; the median distance between two sciatic tubercles was 92.5 (78-100) mm; the median distance between the inferior margin of tumor to the anal verge was 4 (2-5) cm; the median operation time was 302 (215-402) min; the median intraoperative blood loss was 100 (50-200) ml; the median postoperative hospital stay was 9 (5-15) d. Postoperative complications occurred in 5 patients (25%), including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure (41.5±8.6) mmHg and squeeze pressure (121.0±11.6) mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node metastasis and no local recurrence was found.
The safety of transanal total mesorectal excision for male patients with low rectal cancer and difficult pelvis is acceptable. TaTME is helpful to preserve the anal sphincter.
探讨经肛门全直肠系膜切除术（taTME）在骨盆狭窄的男性低位直肠癌患者（“困难骨盆”）中的应用价值，此类患者的保肛手术无论是开放手术还是腹腔镜手术都颇具难度。
收集2016年6月至2018年1月在北京大学肿瘤医院接受taTME手术且经病理确诊的男性低位直肠癌患者的临床资料，进行回顾性队列研究。患者入选标准如下：（1）低位直肠癌，肿瘤下缘距肛缘≤5 cm；（2）双侧坐骨结节间距<5 cm；（3）体重指数（BMI）>25 kg/m²；（4）肿瘤横径≤4 cm。分析手术时间、术中出血量、术后住院时间、术后并发症及肛门功能。
本研究共纳入20例患者。所有患者均接受术前新辅助放化疗及经腹经肛联合手术。BMI中位数为27.7（26.2 - 36.4）kg/m²；双侧坐骨结节间距中位数为92.5（78 - 100）mm；肿瘤下缘距肛缘中位数为4（2 - 5）cm；手术时间中位数为302（215 - 402）min；术中出血量中位数为100（50 - 200）ml；术后住院时间中位数为9（5 - 15）d。5例患者（25%）发生术后并发症，其中盆腔感染3例，肠梗阻1例，吻合口漏1例行乙状结肠造瘘。无围手术期死亡。保肛率为100%。19例患者术后1个月行肛门测压，静息压（41.5±8.6）mmHg，挤压压（121.0±11.6）mmHg，均正常。所有患者随访至2018年3月，中位随访时间为4.5个月。仅1例患者出现锁骨上淋巴结转移，未发现局部复发。
经肛门全直肠系膜切除术用于骨盆狭窄的男性低位直肠癌患者，安全性尚可。TaTME有助于保留肛门括约肌。
