Roodbeen Sapho X, Penna Marta, van Dieren Susan, Moran Brendan, Tekkis Paris, Tanis Pieter J, Hompes Roel
Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
J Natl Compr Canc Netw. 2021 Aug 17;19(11):1232-1240. doi: 10.6004/jnccn.2021.7012.
The oncologic safety of transanal total mesorectal excision (TaTME) for rectal cancer has recently been questioned, with high local recurrence (LR) rates reported in Dutch and Norwegian experiences. The objective of this study was to evaluate the oncologic safety of TaTME in a large cohort of patients with primary rectal cancer, primarily in terms of LR, disease-free survival (DFS), and overall survival (OS).
This was a prospective international registry cohort study, including all patients who underwent TaTME for primary rectal adenocarcinoma from February 2010 through December 2018. The main endpoints were 2-year LR rate, pattern of LR, and independent risk factors for LR. Secondary endpoints included 2-year DFS and OS rates. Kaplan-Meier survival analysis was used to calculate actuarial LR, DFS, and OS rates.
A total of 2,803 patients receiving primary TaTME were included, predominantly men (71%) with a median age of 65 years (interquartile ratio, 57-73 years). After a median follow-up of 24 months (interquartile ratio, 12-38 months), the 2-year LR rate was 4.8% (95% CI, 3.8%-5.8%) with a unifocal LR pattern in 99 of 103 patients (96%). Independent risk factors for LR were male sex, threatened resection margin on baseline MRI, pathologic stage III cancer, and a positive circumferential resection margin on final histopathology. The 2-year DFS and OS rates were 77% (95% CI, 75%-79%) and 92% (95% CI, 91%-93%), respectively.
This largest TaTME cohort to date supports the oncologic safety of the TaTME technique for rectal cancer in patients treated in units that contributed to an international registry, with an acceptable 2-year LR rate and a predominantly unifocal LR pattern.
经肛门全直肠系膜切除术（TaTME）治疗直肠癌的肿瘤学安全性最近受到质疑，荷兰和挪威的经验报告显示局部复发（LR）率较高。本研究的目的是评估TaTME在一大群原发性直肠癌患者中的肿瘤学安全性，主要从LR、无病生存期（DFS）和总生存期（OS）方面进行评估。
这是一项前瞻性国际注册队列研究，纳入了2010年2月至2018年12月期间接受TaTME治疗原发性直肠腺癌的所有患者。主要终点为2年LR率、LR模式以及LR的独立危险因素。次要终点包括2年DFS和OS率。采用Kaplan-Meier生存分析来计算精算LR、DFS和OS率。
共纳入2803例接受原发性TaTME的患者，以男性为主（71%），中位年龄65岁（四分位间距，57 - 73岁）。中位随访24个月（四分位间距，12 - 38个月）后，2年LR率为4.8%（95%CI，3.8% - 5.8%），103例患者中有99例（96%）为单灶性LR模式。LR的独立危险因素为男性、基线MRI提示切除边缘受威胁、病理分期为III期癌症以及最终组织病理学检查切缘阳性。2年DFS和OS率分别为77%（95%CI，75% - 79%）和92%（95%CI，91% - 93%）。
这一迄今为止最大的TaTME队列研究支持在参与国际注册的单位接受治疗的患者中，TaTME技术治疗直肠癌的肿瘤学安全性，2年LR率可接受且主要为单灶性LR模式。
