Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK.
Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
Colorectal Dis. 2019 Oct;21(10):1164-1174. doi: 10.1111/codi.14730. Epub 2019 Jul 1.
Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.
Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period.
One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%.
Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.
经肛门内镜微创手术（TEM）进行的早期直肠癌保肛局部切除术与正规直肠癌切除术相比，发病率明显更低，但治疗效果可接受。本研究介绍了我们在英国一家专门的早期直肠癌多学科团队（MDT）中，对直肠病变患者进行 TEM 治疗的 6 年经验。
对在 6 年内，因疑似早期直肠癌而被转诊至区域早期直肠癌多学科团队（MDT）的所有接受 TEM 治疗的患者进行数据收集。
共有 141 例疑似或确诊早期直肠癌患者接受了全层 TEM 治疗。30 例患者因不完全内镜息肉切除术而被转至 TEM 治疗。最终病理结果显示，77 例（54.6%）为良性，64 例（45.4%）为恶性。在 61 例确诊的腺癌中，TEM 切除标本中 pT0 为 17 例（27.9%），pT1 为 32 例（51.7%），pT2 为 11 例（18.0%），pT3 为 1 例（1.6%）。38 例（62.3%）患者有 1 个或多个不良组织学预后特征，这些患者被建议接受进一步治疗。61 例直肠腺癌患者中，23 例（37.7%）在 TEM 治疗后无需进一步治疗。43 例直肠腺癌患者可用于建立复发率。在中位随访 28.7 个月（12.1-66.5 个月）时，有 2 例（4.7%）患者出现复发。总的 5 年总生存率为 87.9%，无疾病生存率为 82.9%。
通过早期直肠癌 MDT，在专门的区域中心进行 TEM 手术，对患者进行适当的选择、有效的技术、专家组织病理学、适当的辅助治疗转诊和细致的随访，即可获得可接受的治疗效果。
