Department of General Surgery, Affiliated Nanping First Hospital, Fujian Medical University, 317 Zhongshan Road, Nanping, 353000, Fujian, China.
Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China.
World J Surg Oncol. 2022 Feb 22;20(1):43. doi: 10.1186/s12957-022-02521-5.
The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach.
We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n = 142), the transabdominal perineal approach for ISR (TPAISR, n = 57), or the transanal pull-through approach for ISR (PAISR, n = 36).
The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, 3-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups.
TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.
不同入路腹腔镜经括约肌间直肠切除术（LAISR）治疗低位直肠癌的手术效果存在差异，且每种术式的最佳疗效相关的患者特征尚未报道。我们比较了 LAISR 治疗低位直肠癌的不同入路的疗效，并讨论了每种入路的手术适应证。
我们回顾性分析了 2010 年 10 月至 2016 年 9 月接受 LAISR 治疗的 235 例低位直肠癌患者的数据。患者接受经腹 ISR（TAISR，n=142）、经腹会阴 ISR（TPAISR，n=57）或经肛门直肠内拉出 ISR（PAISR，n=36）。
PAISR 和 TAISR 组的手术时间和术中出血量均短于 TPAISR 组，PAISR 和 TPAISR 组的吻合口距离均短于 TAISR 组。三组患者在根治性切除能力、总并发症、术后恢复、造口关闭后 12 个月的 Wexner 评分、3 年无病生存率、局部无复发生存率、无远处转移生存率和总生存率（OS）方面均无差异。
TAISR、TPAISR 和 PAISR 具有各自的优势，在手术安全性、患者结局和肛门功能方面无差异。TPAISR 完成时间更长，出血更多，肛门功能恢复更慢。当 TAISR 不能保证阴性远端切缘且肿瘤和 BMI 较小时应考虑 PAISR，否则应采用 TPAISR。
