Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Tauli University Hospital, Universitat Autònoma de Barcelona (UAB), Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.
Tech Coloproctol. 2019 Sep;23(9):869-876. doi: 10.1007/s10151-019-02071-1. Epub 2019 Aug 28.
Transanal endoscopic microsurgery (TEM) has become the treatment of choice for benign rectal lesions and early rectal cancer (T1). The size classification of rectal polyps is controversial. Some articles define giant rectal lesions as those larger than 5 cm, which present a significantly increased risk of complications. The aim of this study was to evaluate the feasibility of TEM in these lesions.
An observational descriptive study with prospective data collection evaluating the feasibility of TEM in large rectal adenomas was performed between June 2004 and September 2018. Patients were assigned to one of the three groups according to size: < 5 cm, very large (5-7.9 cm) and ultra-large (≥ 8 cm). Descriptive and comparative analyses between groups were performed.
TEM was indicated in 761 patients. Five hundred and seven patients (66.6%) with adenoma in the preoperative biopsy were included in the study. Three hundred and nine out of 507 (60.9%) tumors < 5 cm, 162/507 (32%) very large tumors (5-7.9 cm) and 36/507 (7.1%) ultra-large tumors (≥ 8 cm) were reviewed. Morbidity increased with tumor size: 17.5% in tumors < 5 cm, 26.5% in those 5-7.9 cm, and 36.1% in those > 8 cm. Peritoneal perforation, fragmentation, free margins and stenosis were also more common in very large and ultra-large tumors (p < 0.001). There were no statistical differences between the groups in the definitive pathology (p = 0.38).
TEM in these large tumors is associated with higher rates of morbidity, peritoneal perforation, free margins and stenosis. Although these tumors do not require total mesorectal excision and are eligible for TEM, the surgery must be carried out by experienced surgeons.
经肛门内镜微创手术（TEM）已成为治疗良性直肠病变和早期直肠癌（T1）的首选方法。直肠息肉的大小分类存在争议。一些文章将巨大直肠病变定义为大于 5cm 的病变，这些病变的并发症风险显著增加。本研究旨在评估 TEM 在这些病变中的可行性。
这是一项观察性描述性研究，前瞻性收集数据，评估 2004 年 6 月至 2018 年 9 月期间 TEM 在大型直肠腺瘤中的可行性。根据大小将患者分为三组：<5cm、超大（5-7.9cm）和特大（≥8cm）。对组间进行描述性和对比分析。
TEM 适用于 761 例患者。507 例（66.6%）术前活检为腺瘤的患者被纳入研究。309 例（60.9%）肿瘤<5cm，162/507（32%）肿瘤为超大（5-7.9cm），36/507（7.1%）肿瘤为特大（≥8cm）。肿瘤越大，发病率越高：肿瘤<5cm 为 17.5%，5-7.9cm 为 26.5%，>8cm 为 36.1%。超大和特大肿瘤更容易发生腹膜穿孔、碎裂、游离边缘和狭窄（p<0.001）。各组在明确的病理学上无统计学差异（p=0.38）。
在这些大型肿瘤中，TEM 与更高的发病率、腹膜穿孔、游离边缘和狭窄相关。尽管这些肿瘤不需要完全直肠系膜切除，并且适合 TEM，但手术必须由经验丰富的外科医生进行。
