Department of Surgery, Lugano Regional Hospital, via Tesserete 46, Lugano, 6900, Switzerland.
Department of Surgery, Beata Vergine Hospital, Via Alfonso Turconi 23, Mendrisio, 6850, Switzerland.
Int J Colorectal Dis. 2021 Oct;36(10):2271-2279. doi: 10.1007/s00384-021-04019-0. Epub 2021 Sep 1.
Transanal total mesorectal excision (TaTME) has been proposed as an alternative to laparoscopic total mesorectal excision (LapTME) in distal rectal tumors. Despite encouraging reports, mid- and long-term oncological results are limited. In this study, we aimed at comparing TaTME versus LapTME in patients with mid and low rectal cancer.
From January 2012 to December 2019, all patients undergoing either TaTME or LapTME for rectal adenocarcinoma ≤ 12 cm from the anal verge were included. Demographic, clinical, and follow-up data were retrieved from a prospective and audited database, and a propensity score-matched analysis was performed.
A total of 144 patients were included, 38 underwent TaTME, and 106 LapTME. The median age was 68.0 (60.2-75.8) years, and 96 (66.7%) patients were male. Median follow-up was 30.6 (20.2-39.8) months in the TaTME group and 49.5 (22.6-68.5) months in the LapTME group. There was one (2.6%) local recurrence in the TaTME group and two (1.9%) in the LapTME group (p = 0.788). There was no difference in the 3-year disease-free survival between groups both in the primary (93% vs. 86%, p = 0.274) and the propensity score-matched analyses (93% vs. 81%, p = 0.132). Conversion to open surgery was less frequent in the TaTME group (none vs. 4 (11.4%), p = 0.041). Intra- and postoperative complications, length of stay, specimen quality, and resection margins were similar between groups.
In our experience, TaTME was associated with a less frequent conversion to open surgery but otherwise had similar post-operative results compared to LapTME. Local recurrence and 3-year survival rates were similar.
经肛门全直肠系膜切除术（TaTME）已被提议作为远端直肠肿瘤腹腔镜全直肠系膜切除术（LapTME）的替代方法。尽管有令人鼓舞的报道，但中、长期肿瘤学结果是有限的。在这项研究中，我们旨在比较 TaTME 与 LapTME 在中低位直肠腺癌患者中的疗效。
从 2012 年 1 月至 2019 年 12 月，所有接受 TaTME 或 LapTME 治疗肛缘距离直肠腺癌≤12cm 的患者均纳入研究。从一个前瞻性和审核的数据库中获取人口统计学、临床和随访数据，并进行倾向评分匹配分析。
共纳入 144 例患者，其中 38 例行 TaTME，106 例行 LapTME。中位年龄为 68.0（60.2-75.8）岁，96 例（66.7%）为男性。TaTME 组的中位随访时间为 30.6（20.2-39.8）个月，LapTME 组为 49.5（22.6-68.5）个月。TaTME 组有 1 例（2.6%）局部复发，LapTME 组有 2 例（1.9%）（p=0.788）。两组患者在原发肿瘤（93% vs. 86%，p=0.274）和倾向评分匹配分析（93% vs. 81%，p=0.132）中的 3 年无病生存率无差异。TaTME 组中转开腹手术的频率较低（0 例 vs. 4 例（11.4%），p=0.041）。术中及术后并发症、住院时间、标本质量和切缘均无差异。
根据我们的经验，与 LapTME 相比，TaTME 更不容易转为开腹手术，但术后结果相似。局部复发率和 3 年生存率相似。
