U.O.C. Chirurgia Generale 2, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Tech Coloproctol. 2021 Mar;25(3):319-331. doi: 10.1007/s10151-020-02394-4. Epub 2021 Jan 18.
The aim of this study was to quantify the incidence of short-term postoperative complications and functional disorders at 1 year from transanal endoscopic microsurgery (TEM) for rectal neoplasms, to compare patients treated with TEM alone and with TEM after preoperative chemoradiotherapy (CRT) and to analyse factors influencing postoperative morbidity and functional outcomes.
A retrospective study was conducted on all patients treated with TEM for rectal neoplasms at our institution in January 2000-December 2017. Data from a prospectively maintained database were retrospectively analysed. Patients were divided into two groups: adenoma or early rectal cancer (no CRT group) and locally advanced extraperitoneal rectal cancer with major or complete clinical response after preoperative CRT (CRT group). Short-term postoperative mortality and morbidity and the functional results at 1 year were recorded. The two groups were compared, and a statistical analysis of factors influencing postoperative morbidity and functional outcomes was performed. Functional outcome was also evaluated with the low anterior resection syndrome (LARS) score (0-20 no LARS, 21-29 minor LARS and 30-42 major LARS).
One hundred and thirteen patients (71 males, 42 females, median age 64 years [range 41-80 years]) were included in the study (46 in the CRT group). The overall postoperative complication rate was 23.0%, lower in the noCRT group (p < 0.001), but only 2.7% were grade ≥ 3. The most frequent complication was suture dehiscence (17.6%), which occurred less frequently in the noCRT group (p < 0.001). At 1 year from TEM, the most frequent symptoms was urgency (11.9%, without significant differences between the CRT group and the noCRT group); the noCRT group experienced a lower rate of soiling than the CRT group (0% vs. 7.7%; p: 0.027). The incidence of LARS was evaluated in 47 patients from May 2012 on and was 21.3% occurring less frequently in the noCRT group (10% vs. 41.2%; p: 0.012). Only 6.4% of the patients evaluated experienced major LARS. In multivariate analysis, preoperative CRT significantly worsened postoperative morbidity and functional outcomes.
TEM is a safe procedure associated with only low risk of severe postoperative complications and major LARS. Preoperative CRT seems to increase the rate of postoperative morbidity after TEM and led to worse functional outcomes at 1 year after surgery.
本研究旨在定量分析经肛门内镜微创手术（TEM）治疗直肠肿瘤 1 年后短期术后并发症和功能障碍的发生率，比较单独接受 TEM 治疗与术前放化疗（CRT）后接受 TEM 治疗的患者，并分析影响术后发病率和功能结果的因素。
对 2000 年 1 月至 2017 年 12 月在我院接受 TEM 治疗的直肠肿瘤患者进行回顾性研究。对前瞻性维护的数据库中的数据进行回顾性分析。患者分为两组：腺瘤或早期直肠癌（无 CRT 组）和局部晚期腹膜外直肠肿瘤，术前 CRT 后有主要或完全临床反应（CRT 组）。记录短期术后死亡率和发病率以及 1 年后的功能结果。比较两组，并对影响术后发病率和功能结果的因素进行统计学分析。还使用低位前切除术综合征（LARS）评分（0-20 无 LARS，21-29 轻度 LARS 和 30-42 重度 LARS）评估功能结果。
共纳入 113 例患者（71 名男性，42 名女性，中位年龄 64 岁[范围 41-80 岁]）（CRT 组 46 例）。总的术后并发症发生率为 23.0%，无 CRT 组较低（p<0.001），但只有 2.7%为 3 级以上。最常见的并发症是缝合线裂开（17.6%），无 CRT 组较少见（p<0.001）。TEM 后 1 年，最常见的症状是尿急（11.9%，CRT 组和无 CRT 组之间无显著差异）；无 CRT 组的污染发生率低于 CRT 组（0% vs. 7.7%；p：0.027）。2012 年 5 月后对 47 例患者进行了 LARS 发生率评估，发生率为 21.3%，无 CRT 组较低（10% vs. 41.2%；p：0.012）。仅 6.4%的评估患者出现严重 LARS。多变量分析显示，术前 CRT 显著增加 TEM 术后发病率和功能结果恶化。
TEM 是一种安全的手术，术后严重并发症和重度 LARS 的风险较低。术前 CRT 似乎增加了 TEM 后术后发病率，并导致术后 1 年时功能结果更差。
