Li Ze, Xiao Jingkun, Hou Yujie, Zhang Xingwei, Jie Haiqing, Liu Huashan, Ruan Lei, Zeng Ziwei, Kang Liang
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
Gastroenterol Res Pract. 2022 Feb 27;2022:2387464. doi: 10.1155/2022/2387464. eCollection 2022.
Since Sylla and Lacy successfully reported the transanal total mesorectal excision in 2010, taTME was considered to have the potential to overcome some problematic laparoscopic cases in male, low advanced rectal cancer. However, the evidence is still lacking. This study compared the short and long outcomes of taTME with laTME in these "challenging" patients to explore the advantages of taTME among the patients.
After propensity score matching analysis, 106 patients were included in each group from 325 patients who met the including standard. Statistical analysis was used to compare the differences of perioperative outcomes, histopathological results, and survival results between taTME and laTME groups.
The mean time of pelvic operation in the taTME group was significantly shorter than in the laTME group (62.2 ± 14.2 mins vs 81.1 ± 18.9 mins, = 0.003). The complication incidence rate and the rate of protective loop ileostomy in the taTME group were significantly lower than those in the laTME group (19.8% vs 38.7%, = 0.003 and 70.8% vs 92.5%, < 0.001). In long-term result, there was no significant difference between the two groups for 3-year OS (87.3% vs 85.4%, = 0.86) or 3-year DFS (74.9% vs 70.1%, = 0.92). The 2-year cumulative local recurrence rate was similar between the two groups (1.1% vs 5.8%, = 0.22).
This study demonstrated that taTME might reduce the incidence of postoperative complications, especially of anastomotic leakage in these "challenging" patients. taTME may be considered to have clear advantages for "challenging" patients.
自2010年西拉和莱西成功报道经肛门全直肠系膜切除术以来，经肛门全直肠系膜切除术被认为有潜力克服男性低位进展期直肠癌一些有问题的腹腔镜病例。然而，证据仍然不足。本研究比较了经肛门全直肠系膜切除术（taTME）和腹腔镜全直肠系膜切除术（laTME）在这些“具有挑战性”患者中的短期和长期结果，以探讨经肛门全直肠系膜切除术在这些患者中的优势。
在倾向评分匹配分析后，从325例符合纳入标准的患者中每组纳入106例患者。采用统计分析比较经肛门全直肠系膜切除术组和腹腔镜全直肠系膜切除术组围手术期结果、组织病理学结果和生存结果的差异。
经肛门全直肠系膜切除术组盆腔手术平均时间明显短于腹腔镜全直肠系膜切除术组（62.2±14.2分钟对81.1±18.9分钟，P = 0.003）。经肛门全直肠系膜切除术组并发症发生率和保护性回肠造口术发生率明显低于腹腔镜全直肠系膜切除术组（19.8%对38.7%，P = 0.003；70.8%对92.5%，P<0.001）。在长期结果方面，两组3年总生存率（87.3%对85.4%，P = 0.86）或3年无病生存率（74.9%对70.1%，P = 0.92）无显著差异。两组2年累积局部复发率相似（1.1%对5.8%，P = 0.22）。
本研究表明，经肛门全直肠系膜切除术可能降低这些“具有挑战性”患者术后并发症的发生率，尤其是吻合口漏的发生率。对于“具有挑战性”的患者，经肛门全直肠系膜切除术可能被认为具有明显优势。
