评估重复经肛门内镜微创手术的安全性和结果。
Assessing the safety and outcomes of repeat transanal endoscopic microsurgery.
机构信息
Division of General Surgery, Vancouver General Hospital, 950 West 10th Avenue, Vancouver, Canada.
Department of Surgery, St. Paul's Hospital, Vancouver, BC, Canada.
出版信息
Surg Endosc. 2019 Jun;33(6):1976-1980. doi: 10.1007/s00464-018-6501-9. Epub 2019 Feb 11.
BACKGROUND
Transanal endoscopic microsurgery (TEM) is the treatment of choice for benign rectal tumors and select early rectal cancers. This surgical approach has become ubiquitous and surgeons are seeing recurrent lesions after TEM resection. This study aims to outline the safety and outcomes of repeat TEM when compared to primary TEM procedures.
METHODS
At St. Paul's Hospital, demographic, surgical, pathologic, and follow-up data for patients treated by TEM are maintained in a prospectively populated database. Two groups were established for comparison: patients undergoing first TEM procedure (TEM-P) and patients undergoing repeat TEM procedure (TEM-R).
RESULTS
Between 2007 and 2017, 669 patients had their first TEM procedure. Over this time frame, 57 of these patients required repeat TEM procedures, including 15 of these patients treated by 3 or more TEMs. Indications for repeat TEM included recurrence (78%), positive margins (15%), and metachronous lesions (7%). There were no differences between the groups in patient age, gender, or tumor histology. Compared to TEM-P, TEM-R had shorter operative times (38 vs. 52 min, p < 0.001), more distal lesions (5 vs. 7 cm, p < 0.004), and smaller lesions (3 vs. 4 cm, p < 0.0003). The TEM-R group had similar length of hospital stay (0.45 vs. 0.56 days, p = 0.65), rates of clear margins on pathology (81% vs. 88%, p = 0.09), and 30-day readmission rates (7% vs. 4%, p = 0.27) when compared to TEM-P group. TEM-R was more likely to be managed without suturing the surgical defect (72% vs. 32%, p < 0.0001). Repeat TEM was associated with similar post-operative complications as primary TEM graded on the Clavien-Dindo classification scale (Grade 1: 5% vs. 5%, Grade 2: 5% vs. 4%, Grade 3: 5% vs. 1%, p = 0.53). No 30-day mortality occurred in either group.
CONCLUSIONS
The St. Paul's Hospital TEM experience suggests repeat TEM is a safe and feasible procedure with similar outcomes as patients undergoing first TEM.
背景
经肛门内镜微创手术（TEM）是治疗良性直肠肿瘤和选择早期直肠肿瘤的首选方法。这种手术方法已经无处不在，外科医生在 TEM 切除术后会看到复发性病变。本研究旨在概述与初次 TEM 手术相比，重复 TEM 的安全性和结果。
方法
在圣保罗医院，通过 TEM 治疗的患者的人口统计学、手术、病理和随访数据都保存在一个前瞻性的数据库中。为了比较，建立了两组：行初次 TEM 手术的患者（TEM-P）和行重复 TEM 手术的患者（TEM-R）。
结果
2007 年至 2017 年间，有 669 名患者接受了初次 TEM 手术。在此期间，其中 57 名患者需要重复 TEM 手术，其中 15 名患者接受了 3 次或更多次 TEM 治疗。重复 TEM 的指征包括复发（78%）、切缘阳性（15%）和同时性病变（7%）。两组患者的年龄、性别或肿瘤组织学无差异。与 TEM-P 相比，TEM-R 的手术时间更短（38 分钟 vs. 52 分钟，p<0.001），病变位置更靠下（5 厘米 vs. 7 厘米，p<0.004），病变更小（3 厘米 vs. 4 厘米，p<0.0003）。TEM-R 组的住院时间（0.45 天 vs. 0.56 天，p=0.65）、病理切缘清晰率（81% vs. 88%，p=0.09）和 30 天再入院率（7% vs. 4%，p=0.27）与 TEM-P 组相似。与 TEM-P 组相比，TEM-R 更有可能不缝合手术缺损（72% vs. 32%，p<0.0001）。根据 Clavien-Dindo 分类系统，TEM-R 术后并发症与初次 TEM 相似（1 级：5% vs. 5%，2 级：5% vs. 4%，3 级：5% vs. 1%，p=0.53）。两组均无 30 天死亡病例。
结论
圣保罗医院 TEM 的经验表明，重复 TEM 是一种安全可行的方法，其结果与初次 TEM 手术相似。
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