中低位直肠癌经肛门全直肠系膜切除术与标准腹腔镜全直肠系膜切除术的 3 年疗效比较。
Three-year outcomes of transanal total mesorectal excision versus standard laparoscopic total mesorectal excision for mid and low rectal cancer.
机构信息
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People's Republic of China.
Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People's Republic of China.
出版信息
Surg Endosc. 2022 Jun;36(6):3902-3910. doi: 10.1007/s00464-021-08707-4. Epub 2021 Aug 27.
INTRODUCTION
Since transanal total mesorectal excision (taTME) was introduced, it has become an important topic in rectal cancer treatment. Many previous studies reported positive relevant short-term results, histopathological results, and associated complications. Recently, concerns regarding the oncological safety of taTME have been raised due to reports showing high local recurrences (LR) rates. Therefore, this study aimed to compare the 3-year outcomes between taTME and laparoscopic total mesorectal excision (laTME) for mid-low rectal cancer.
METHODS
A total of 104 patients who underwent taTME were matched with 208 patients treated by laTME. The primary endpoint was 3-year LR rate; secondary endpoints in this matched-cohort study included the perioperative outcomes and histopathological outcomes.
RESULTS
taTME was associated with lower permanent ostomy rate (1% vs 13.5%) and lower conversion rate (0% vs 3.4%) compared to laTME. A similar quality of resected specimens was detected for each group. In both groups, the local recurrence rate was 3.8%. Within 3 years after surgery, the disease-free survival (DFS) rates were 78.8% in the taTME group and 76.9% in the laTME group (P = 0.640), while the overall survival (OS) rates were 93.3% in the taTME group and 89.9% in the laTME group (P = 0.327).
CONCLUSION
No significant differences regarding 3-year local recurrence rate (3.8%) were observed in the taTME group compared to laTME group.
简介
自从经肛门全直肠系膜切除术（taTME）问世以来，它已成为直肠癌治疗的一个重要课题。许多先前的研究报告了积极的相关短期结果、组织病理学结果和相关并发症。最近，由于报告显示局部复发率（LR）较高，人们对 taTME 的肿瘤学安全性产生了担忧。因此，本研究旨在比较 taTME 与腹腔镜全直肠系膜切除术（laTME）治疗中低位直肠癌的 3 年结果。
方法
共纳入 104 例行 taTME 的患者与 208 例行 laTME 治疗的患者进行匹配。主要终点是 3 年 LR 率；本匹配队列研究的次要终点包括围手术期结局和组织病理学结局。
结果
与 laTME 相比，taTME 具有更低的永久性造口率（1%比 13.5%）和更低的转化率（0%比 3.4%）。两组标本的切除质量相似。两组局部复发率均为 3.8%。手术后 3 年内，taTME 组无病生存率（DFS）为 78.8%，laTME 组为 76.9%（P=0.640），总生存率（OS）分别为 93.3%和 89.9%（P=0.327）。
结论
与 laTME 组相比，taTME 组 3 年局部复发率（3.8%）无显著差异。
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