Department of Colorectal Surgery, University Hospital Leon, Leon, Spain.
Department of Colorectal Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain.
Surg Endosc. 2021 Apr;35(4):1808-1819. doi: 10.1007/s00464-020-07579-4. Epub 2020 Apr 24.
There is no consensus regarding the gold standard technique for rectal cancer as Total Mesorectal Excision (TME) may be safely performed either by open or minimally invasive surgery. The laparoscopic approach, however, may carry technical difficulties. For this reason, a novel technique has emerged in the last decade combining a dual laparoscopic dissection (abdominal and transanal) to perform the TME technique (TaTME). When focusing on oncological outcomes, there is a lack of literature regarding mid-long term results. The aim of this study is to evaluate the mid-term oncological impact of TaTME for treating rectal cancer.
A prospective multicentre study was performed in four tertiary centres including consecutive patients who underwent TaTME for mid-low rectal cancer by the same group of experienced surgeons. The analysed data included pathological results on the quality of TME and mid-term oncological outcomes.
In total, 173 patients were included throughout a study period of 6 years. Our series included 70% males and 68% of patients with neoadjuvant treatments. The median follow-up was 23 [15-37.5] months. Regarding pathological results, a complete TME was achieved in 72.8%, while circumferential and distal margins were affected in 1.4 and 1.1%, respectively. Five patients developed local recurrences (3%) and 8.1% presented distant disease during the follow-up. The 2-year disease-free survival and the overall survival rates were 88% and 95%, respectively.
There is currently a lack of evidence in the literature regarding TaTME and oncological outcomes with no data available from randomized clinical trials. In the meantime, the reported results from different multicentre series are controversial. This study showed positive mid-term outcomes at 2 years of follow-up and supported notable oncological outcomes with TaTME. However, it must be emphasized that previous experience in minimally invasive and transanal surgeries is essential for surgeons before intending to perform TaTME.
目前对于直肠癌，尚无金标准治疗方法，全直肠系膜切除术（TME）既可以通过开放手术也可以通过微创手术安全施行。然而，腹腔镜手术可能存在技术困难。因此，在过去十年中出现了一种新的技术，即结合腹部和经肛门双重腹腔镜解剖来施行 TME 技术（TaTME）。当关注肿瘤学结果时，关于中远期结果的文献较少。本研究旨在评估 TaTME 治疗直肠癌的中期肿瘤学影响。
在四家三级中心进行了一项前瞻性多中心研究，纳入了同一组经验丰富的外科医生施行 TaTME 治疗中低位直肠癌的连续患者。分析的数据包括 TME 质量的病理结果和中期肿瘤学结果。
在研究期间，共纳入了 173 例患者，中位随访时间为 23 [15-37.5] 个月。我们的系列研究包括 70%的男性和 68%的新辅助治疗患者。病理结果显示，完全 TME 达到 72.8%，而环周和远端切缘受影响的比例分别为 1.4%和 1.1%。5 例患者发生局部复发（3%），8.1%的患者在随访期间出现远处疾病。2 年无病生存率和总生存率分别为 88%和 95%。
目前，关于 TaTME 和肿瘤学结果的文献证据不足，没有随机临床试验的数据。与此同时，不同多中心系列研究的报告结果存在争议。本研究显示了 2 年随访的中期阳性结果，并支持 TaTME 具有显著的肿瘤学结果。然而，必须强调的是，在打算施行 TaTME 之前，外科医生必须具备微创和经肛门手术的前期经验。
