Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
Department of General Surgery, Tianjin Fifth Central Hospital, Tianjin, 300450, China.
Surg Endosc. 2021 May;35(5):2362-2372. doi: 10.1007/s00464-020-08208-w. Epub 2021 Feb 24.
Intracorporeal rectal transection at the anorectal junction for ultralow rectal cancer is technically difficult due to pelvic width and limited roticulation, which might require a transanal transection or an oblique transection with multiple firings. These procedures were reported to be associated with the increased risk of morbidity. To address these problems, we presented a novel technique Transanterior Obturator Nerve Gateway (TANG) to transect rectum for ultralow rectal cancer and evaluated its safety and feasibility in this study.
A total of 210 consecutive patients who underwent laparoscopic coloanal anastomosis with or without partial intersphincteric resection (CAA/pISR) for rectal cancers between January 2017 and January 2020 were included. Eighty of these patients were analyzed using propensity score matching (PSM). The perioperative characteristics, TANG-related variables, and genitourinary and anal function outcomes were analyzed.
Among these enrolled patients, 170 patients underwent traditional transection, and 40 underwent TANG transection; the patients were matched to include 40 patients in each group by PSM. After PSM, there were no significant differences in the operating time (p = 0.351) or bleeding volume (p = 0.474) between the two groups. However, the TANG group had fewer cases of conversion to transanal transection (0 vs. 13, p < 0.001). Moreover, the patients in TANG group had a more desirable transection with longer distal resection margin (1.7 vs. 1.1 cm, p < 0.001), shorter stapling line (6.6 vs. 10.3 cm, p < 0.001) and fewer stapler firings (p < 0.001). The overall postoperative complication rates and genitourinary and anal function outcomes were not significantly different between the two groups.
The TANG approach appears to be a safe, feasible and effective approach for intracorporeal ultralow rectal transection with more distal resection, more vertical transection and fewer stapler firings.
由于骨盆宽度和有限的旋转度，在肛直肠交界处进行超低直肠的腔内直肠横断术在技术上具有挑战性，这可能需要经肛门横断或多次点火的斜行横断。这些手术被报道与发病率增加有关。为了解决这些问题，我们提出了一种新的技术——经前闭孔神经通道（TANG）来横断超低直肠的直肠，并在本研究中评估了其安全性和可行性。
纳入了 2017 年 1 月至 2020 年 1 月期间因直肠肿瘤接受腹腔镜结肠直肠吻合术（CAA）或伴有部分内括约肌切除术（CAA/pISR）的 210 例连续患者。其中 80 例患者进行了倾向评分匹配（PSM）分析。分析了围手术期特征、TANG 相关变量以及泌尿生殖和肛门功能结果。
在这些入组患者中，170 例患者行传统横断术，40 例患者行 TANG 横断术；通过 PSM 将两组各匹配 40 例患者。PSM 后，两组的手术时间（p=0.351）或出血量（p=0.474）无显著差异。然而，TANG 组中转经肛门横断的病例较少（0 例比 13 例，p<0.001）。此外，TANG 组的横断更理想，远端切除缘更长（1.7cm 比 1.1cm，p<0.001），吻合钉线更短（6.6cm 比 10.3cm，p<0.001），吻合钉点火次数更少（p<0.001）。两组患者的总体术后并发症发生率和泌尿生殖及肛门功能结果无显著差异。
TANG 方法对于腔内超低直肠横断术是一种安全、可行和有效的方法，可实现更远端的切除、更垂直的横断和更少的吻合钉点火次数。
