Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zrab002.
Transanal total mesorectal excision (TaTME) is an innovative technique for distal rectal cancer dissection. It has been shown to have similar short-term outcomes to conventional open and laparoscopic total mesorectal excision (cTME), but recent studies have raised concern about increased morbidity and local recurrence rates. The aim of this study was to assess outcomes after TaTME versus cTME for rectal cancer.
TaTME was implemented in 2014 using IDEAL principles in a single institution. The institution maintains databases for all patients undergoing rectal cancer surgery. This retrospective review compared data collected from all patients who had TaTME with those from a propensity-matched cohort of patients who underwent cTME. The primary outcome was a composite pathological measure combining margin status and quality of total mesorectal excision (TME). Short-term clinical and survival outcomes were also measured.
Propensity matching created 109 matched pairs for analysis. Nine patients (8.3 per cent) undergoing TaTME had positive margins and/or incomplete TME, compared with 11 (10.5 per cent) undergoing cTME (P = 0.65). There were no significant differences in morbidity between the TaTME and cTME groups, including number of anastomotic leaks (13.8 versus 18.3 per cent; P = 0.37). The estimated 3-year local recurrence-free survival rate was 96.3 per cent in both groups (P = 0.39). Estimated 3-year overall (93.6 per cent for TaTME versus 94.5 per cent for cTME; P = 0.09) and disease-free (88.1 versus 76.1 per cent; P = 0.90) survival rates were similar.
TaTME provided similar outcomes to cTME for rectal cancer with the application of IDEAL principles.
经肛门全直肠系膜切除术（TaTME）是一种用于低位直肠癌的创新手术技术。它的短期疗效与传统的开腹和腹腔镜全直肠系膜切除术（cTME）相似，但最近的研究对其增加的发病率和局部复发率表示担忧。本研究旨在评估 TaTME 与 cTME 治疗直肠癌的结果。
2014 年，我们在一家机构中按照 IDEAL 原则实施 TaTME。该机构为所有接受直肠癌手术的患者建立了数据库。本回顾性研究比较了接受 TaTME 的所有患者的数据和接受 cTME 的具有倾向性匹配队列患者的数据。主要结果是结合切缘状态和全直肠系膜切除（TME）质量的复合病理测量。还测量了短期临床和生存结果。
倾向性匹配创建了 109 对匹配的分析。9 例（8.3%）接受 TaTME 的患者存在阳性边缘和/或 TME 不完整，而 11 例（10.5%）接受 cTME 的患者存在阳性边缘和/或 TME 不完整（P=0.65）。TaTME 和 cTME 组之间的发病率没有显著差异，包括吻合口漏的数量（分别为 13.8%和 18.3%；P=0.37）。两组的估计 3 年局部无复发生存率分别为 96.3%（P=0.39）。估计 3 年总生存率（TaTME 为 93.6%，cTME 为 94.5%；P=0.09）和无病生存率（88.1%和 76.1%；P=0.90）相似。
在应用 IDEAL 原则的情况下，TaTME 为直肠癌提供了与 cTME 相似的结果。
