Zhang Chi, Wei Hao-Tang, Hu Wenqing, Sun Yueming, Zhang Qinyuan, Abe Masanobu, Du Zhuoran, Xu Yingying, Zong Liang, Hu Xiang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China.
World J Surg Oncol. 2020 Aug 18;18(1):212. doi: 10.1186/s12957-020-01986-6.
Laparoscopic tumor-specific mesorectal excision (TSME) preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer.
A total of 184 patients with upper rectal cancer were retrospectively analyzed in our cancer center between April 2010 and April 2017. These patients were treated with either laparoscopic TSME (n = 46) or laparoscopic total mesorectal excision (TME) (n = 138). In the TSME group, the left colonic artery and superior rectal artery were preserved while they were not in the TME group.
The operation time in the TSME group was longer than that in the TME group (218.56 ± 35.85 min vs. 201.13 ± 42.65 min, P = 0.004). Furthermore, the number of resected lymph nodes in the TSME group was greater than that in the TME group (19.43 ± 9.46 vs. 18.03 ± 7.43, P = 0.024). The blood loss between the TSME and TME groups was not significant. No mortality occurred in either the TSME or TME groups. One patient in the TME group underwent conversion to laparotomy. The total postoperative complication rates in the TSME and TME groups were 8.7% and 17.4%, respectively. There was no difference in severe complications between the two groups (anastomotic leakage and stenosis).
Laparoscopic TSME preserving the left colic artery and superior rectal artery can be safely conducted for upper rectal cancer.
保留左结肠动脉和直肠上动脉的腹腔镜肿瘤特异性直肠系膜切除术（TSME）在技术上仍然具有挑战性。我们开展这项研究以证明该手术用于上段直肠癌的可行性。
2010年4月至2017年4月期间，我们癌症中心对184例上段直肠癌患者进行了回顾性分析。这些患者接受了腹腔镜TSME（n = 46）或腹腔镜全直肠系膜切除术（TME）（n = 138）治疗。在TSME组中，保留了左结肠动脉和直肠上动脉，而TME组未保留。
TSME组的手术时间比TME组长（218.56 ± 35.85分钟 vs. 201.13 ± 42.65分钟，P = 0.004）。此外，TSME组切除的淋巴结数量多于TME组（19.43 ± 9.46 vs. 18.03 ± 7.43，P = 0.024）。TSME组和TME组之间的失血量无显著差异。TSME组和TME组均未发生死亡。TME组有1例患者转为开腹手术。TSME组和TME组的术后总并发症发生率分别为8.7%和17.4%。两组之间的严重并发症（吻合口漏和狭窄）无差异。
保留左结肠动脉和直肠上动脉的腹腔镜TSME可安全地用于上段直肠癌。
