经肛门全直肠系膜切除术治疗直肠癌的长期肿瘤学结果。
Long-term oncological results after transanal total mesorectal excision for rectal carcinoma.
机构信息
Department of Surgery, Gelderse Vallei Hospital, P.O. Box 9025, 6710 HN, Ede, The Netherlands.
Department of Surgery, Amsterdam University Medical Center, Location VUmc, Cancer Center, Amsterdam, The Netherlands.
出版信息
Tech Coloproctol. 2019 Sep;23(9):903-911. doi: 10.1007/s10151-019-02094-8. Epub 2019 Oct 10.
BACKGROUND
Transanal total mesorectal excision (TaTME) for mid and low rectal cancer has been shown to improve short-term outcomes, mostly due to lower conversion rates and with improved quality of the specimen. However, robust long-term oncological data supporting the encouraging clinical and pathological outcomes are lacking.
METHODS
All consecutive patients undergoing TaTME with curative intent for mid or low rectal cancer in two referral centers in The Netherlands between January 2012 and April 2016 with a complete and minimum follow-up of 36 months were included. The primary outcome was local recurrence rate. Secondary outcomes were disease-free survival, overall survival and development of metastasis.
RESULTS
There were 159 consecutive patients. Their mean age was 66.9 (10.2) years and 66.7% of all patients were men. Pathological analysis showed a complete mesorectum in 139 patients (87.4%), nearly complete in 16 (10.1%) and an incomplete mesorectum in 4 (2.5%). There was involvement of the CRM (< 1 mm) in one patient (0.6%) and no patients had involvement of the distal margin (< 5 mm). Final postoperative staging after neoadjuvant therapy was stage 0 in 11 patients (6.9%), stage I in 73 (45.9%), stage II in 31 (19.5%), stage III in 37 (23.3%) and stage IV in 7 (4.4%). The 3-year local recurrence rate was 2.0% and the 5-year local recurrence rate was 4.0%. Median time to local recurrence was 19.2 months. Distant metastases were found in 22 (13.8%) patients and were diagnosed after a median of 6.9 months (range 1.1-50.4) months. Disease-free survival was 92% at 3 years and 81% at 5 years. Overall survival was 83.6% at 3 years and 77.3% at 5 years.
CONCLUSIONS
The long-term follow-up of the current cohort confirms the oncological safety and feasibility of TaTME in two high volume referral centers for rectal carcinoma. However, further robust and audited data must confirm current findings before widespread implementation of TaTME.
背景
经肛门全直肠系膜切除术（TaTME）治疗中低位直肠癌，已证实可改善短期预后，主要原因是中转开腹率降低，标本质量改善。然而，支持令人鼓舞的临床和病理结果的长期、强有力的肿瘤学数据仍然缺乏。
方法
荷兰两家转诊中心 2012 年 1 月至 2016 年 4 月期间，连续纳入 159 例接受 TaTME 治疗且有明确治愈意向的中低位直肠癌患者，随访时间至少 36 个月。主要结局为局部复发率。次要结局包括无病生存率、总生存率和转移发生率。
结果
患者的平均年龄为 66.9（10.2）岁，66.7%为男性。病理分析显示，139 例（87.4%）患者直肠系膜完整，16 例（10.1%）患者近全直肠系膜完整，4 例（2.5%）患者直肠系膜不完整。1 例（0.6%）患者环周切缘（CRM）受累（<1mm），无患者远端切缘（<5mm）受累。新辅助治疗后，最终术后分期为 0 期 11 例（6.9%），Ⅰ期 73 例（45.9%），Ⅱ期 31 例（19.5%），Ⅲ期 37 例（23.3%），Ⅳ期 7 例（4.4%）。3 年局部复发率为 2.0%，5 年局部复发率为 4.0%。中位局部复发时间为 19.2 个月。22 例（13.8%）患者发生远处转移，中位时间为 6.9 个月（1.1-50.4 个月）。3 年无病生存率为 92%，5 年无病生存率为 81%。3 年总生存率为 83.6%，5 年总生存率为 77.3%。
结论
目前队列的长期随访结果证实，在两家直肠腺癌高容量转诊中心，TaTME 具有肿瘤安全性和可行性。然而，在广泛实施 TaTME 之前，必须有更有力的、经过审核的数据来证实当前的发现。
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