Pacevicius Julius, Petrauskas Vidas, Pilipavicius Lukas, Dulskas Audrius
Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.
Front Surg. 2021 Oct 18;8:746784. doi: 10.3389/fsurg.2021.746784. eCollection 2021.
Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities. This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment. Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min ( = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group ( = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group ( = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group ( = 0.018); major LARS was 7.4 and 13.7%, respectively ( = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group ( = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group ( = 0.964). Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.
我们的目的是比较这两种治疗方式后的肠道功能和肿瘤学结局。这是一项单中心研究，纳入了2009年至2018年间的67例患者。共有32例患者接受了全直肠系膜切除术（TME）组，35例接受了经肛门局部切除术（LE）±放化疗。我们进行了病例匹配分析：根据年龄、癌症分期和合并症对患者进行匹配。比较了手术时间、术后并发症、住院时间以及长期功能和肿瘤学结局。我们使用Cox图计算肿瘤学结局。此外，我们使用低位前切除综合征（LARS）评分来评估肠道功能。LE组的平均手术时间为58.8±45分钟，而TME组为121.1±42分钟（P = 0.032）。LE组的并发症发生率为5.7%，TME组为15.62%（P = 0.043）。LE组约85.2%的患者无LARS，而TME组为54.5%（P = 0.018）。LE组轻度LARS为7.4%，TME组为31.8%（P = 0.018）；重度LARS分别为7.4%和13.7%（P = 0.474）。LE组的住院时间为2.77天，TME组为9.21天（P = 0.036）。LE组的总生存期为68.78个月，TME组为74.81个月（P = 0.964）。我们小样本量的结果表明，与金标准治疗相比，局部切除±放化疗是早期直肠癌一种相当安全的方法。此外，其能保留更好的肠道功能，术后并发症更少，住院时间更短。
