Department Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK.
Surg Endosc. 2019 Aug;33(8):2459-2467. doi: 10.1007/s00464-018-6530-4. Epub 2018 Oct 22.
While a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI.
From June 2013, all consecutive TaTME cases were included and compared to lapTME in a single institution. Propensity score-matching was performed for nine relevant factors. Primary outcome was resection margin involvement (R1), secondary outcomes included intra- and post-operative outcomes.
After matching, forty-one patients were included in each group; no significant differences were observed in patient and tumor characteristics. The resection margin was involved in 5 cases (12.2%) in the laparoscopic group, versus 2 (4.9%) TaTME cases (P = 0.432). The TME specimen quality was complete in 84.0% of the laparoscopic cases and in 92.7% of the TaTME cases (P = 0.266). Median distance to the circumferential resection margin (CRM) was 5 mm in lapTME and 10 mm in TaTME (P = 0.065). Significantly more conversions took place in the laparoscopic group, 9 (22.0%) compared to none in the TaTME group (P < 0.001). Other clinical outcomes did not show any significant differences between the two groups.
This is the first study to compare results of TaTME with lapTME in a highly selected patient group with MRI-defined low rectal tumors. A significant decrease in R1 rate could not be demonstrated, although conversion rate was significantly lower in this TaTME cohort.
虽然直肠肿瘤手术已经向微创技术转变，但腹腔镜在肿瘤学结果方面的非劣效性尚未得到明确证明。经肛门全直肠系膜切除术（TaTME）的开创旨在克服在骨盆深处进行纯腹部手术时遇到的困难。本研究旨在根据 MRI 对低位直肠肿瘤的严格解剖定义，比较 TaTME 与腹腔镜 TME（lapTME）的短期肿瘤学结果。
从 2013 年 6 月开始，所有连续的 TaTME 病例都被纳入研究，并在单家机构与 lapTME 进行比较。对 9 个相关因素进行了倾向评分匹配。主要结局是切缘受累（R1），次要结局包括围手术期结果。
匹配后，每组各纳入 41 例患者；两组患者和肿瘤特征无显著差异。腹腔镜组有 5 例（12.2%）切缘受累，TaTME 组有 2 例（4.9%）（P=0.432）。腹腔镜组的 TME 标本质量完整率为 84.0%，TaTME 组为 92.7%（P=0.266）。腹腔镜组的环周切缘（CRM）距离中位数为 5mm，TaTME 组为 10mm（P=0.065）。腹腔镜组中转手术的比例明显更高，9 例（22.0%），而 TaTME 组无中转（P<0.001）。两组其他临床结果无显著差异。
这是第一项在 MRI 定义的低位直肠肿瘤的高度选择患者组中比较 TaTME 与 lapTME 结果的研究。虽然 TaTME 组的转化率明显较低，但未能证明 R1 率显著降低。
