Gastrounit - Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
Institution of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Surg Endosc. 2022 Feb;36(2):1181-1190. doi: 10.1007/s00464-021-08385-2. Epub 2021 Feb 24.
Transanal endoscopic microsurgery (TEM) represents a choice of treatment in patients with neoplastic lesions in the rectum. When TEM fails, completion total mesorectal excision (cTME) is often required. However, a concern is whether cTME increases the rate of abdominoperineal resections (APR) and is associated with higher risk of incomplete mesorectal fascia (MRF) resection. The aim of this study was to compare outcomes of cTME with primary TME (pTME) in patients with rectal cancer.
This was a nationwide study on all patients with cTME from the Danish Colorectal Cancer Group database between 2005 and 2015. Patients with cTME were compared to patients with pTME after propensity score matching (matching ratio 1:2). Matching variables were age, gender, tumor distance from anal verge, American Society of Anesthesiologists (ASA) score and American Joint Committee on Cancer (AJCC) stage.
A total of 60 patients with cTME were compared with 120 patients with pTME. Patients with cTME experienced more intraoperative complications as compared to pTME patients (18.3% vs. 6.7%, p = 0.021). However, there was no difference in the rate of perforations at or near the tumor/previous TEM site (6.7% vs. 2.5%, p = 0.224), conversion to open surgery (p = 0.733) or 30-day morbidity (p = 0.86). On multivariate analysis, cTME was not a risk factor for APR (OR 2.49; 95% CI 0.95-6.56; p = 0.064) or incomplete MRF (OR 1.32; 95% CI 0.48-3.63; p = 0.596). There was no difference in the rate of local recurrence between cTME and pTME (5.2% vs. 4.3%, p = 0.1), distant metastases (6.8% vs. 6.8%, p = 1), or survival (p = 0.081). The mean follow-up time was 6 years.
In our study, the largest so far on the subject, we find no difference in postoperative short- or long-term outcomes between cTME and pTME.
经肛门内镜微创手术（TEM）是直肠肿瘤患者的一种治疗选择。当 TEM 失败时，通常需要完成全直肠系膜切除术（cTME）。然而，人们担心 cTME 是否会增加腹会阴切除术（APR）的发生率，并与不完全直肠筋膜（MRF）切除的风险增加有关。本研究旨在比较 cTME 与原发性 TEM（pTME）治疗直肠癌患者的结果。
这是一项在丹麦结直肠癌组数据库中对所有接受 cTME 的患者进行的全国性研究，时间范围为 2005 年至 2015 年。在倾向评分匹配（匹配比例 1:2）后，将接受 cTME 的患者与接受 pTME 的患者进行比较。匹配变量为年龄、性别、肿瘤距肛缘的距离、美国麻醉医师协会（ASA）评分和美国癌症联合委员会（AJCC）分期。
共比较了 60 例 cTME 患者和 120 例 pTME 患者。cTME 组术中并发症发生率高于 pTME 组（18.3%比 6.7%，p=0.021）。然而，在肿瘤/先前 TEM 部位或附近穿孔的发生率（6.7%比 2.5%，p=0.224）、转为开放性手术（p=0.733）或 30 天发病率（p=0.86）方面，两组无差异。多因素分析显示，cTME 不是 APR（OR 2.49；95%CI 0.95-6.56；p=0.064）或不完全 MRF（OR 1.32；95%CI 0.48-3.63；p=0.596）的危险因素。cTME 组与 pTME 组局部复发率（5.2%比 4.3%，p=0.1）、远处转移率（6.8%比 6.8%，p=1）或生存率（p=0.081）无差异。中位随访时间为 6 年。
在我们这项迄今为止最大的研究中，我们发现 cTME 与 pTME 之间在术后短期和长期结果方面没有差异。
