Ryzhikh National Medical Research Center for Coloproctology, Moscow, Russia.
Russian Medical Academy for Continuous Professional Education, Moscow, Russia.
Khirurgiia (Mosk). 2022(4):34-41. doi: 10.17116/hirurgia202204134.
To analyze early and long-term outcomes after total mesorectal excision (TME) and transanal endoscopic microsurgery (TEM) in patients with T1 rectal cancer.
A retrospective non-randomized comparative study included 2 groups of patients: group 1 - total mesorectal excision, group 2 - transanal endoscopic microsurgery. In the second group, total mesorectal excision was proposed for patients with tumor invasion depth pT1sm3 and/or lymphovascular invasion and/or low differentiation. If total mesorectal excision was performed as a salvage surgery, the patient was excluded from further analysis.
There were 156 patients with rectal adenocarcinoma pT1 between October 2011 and August 2019 (102 cases - TEM, 54 cases - TME). We excluded 10 patients from the TEM group due to salvage surgery. Duration of TEM was 40.0 (34; 50) min, TME - 139 (120; 180) min (=0.00001). Postoperative hospital-stay was also significantly less in the TEM group (7 (6; 9) vs. 10 (7; 11) days, =0.00001). Six (6.5%) patients in the TEM group and 1 (1.8%) patient in the TME group developed a local recurrence in pelvic cavity (=0.1). There were no distant metastases. Disease-free 3-year survival was 92% after TEM and 96% after TME (=0.058).
Transanal endoscopic microsurgery is a relatively safe alternative to total mesorectal excision for early rectal cancer.
分析 T1 期直肠癌患者行全直肠系膜切除术（TME）和经肛门内镜微创手术（TEM）的早期和长期疗效。
回顾性非随机对照研究纳入两组患者：TME 组和 TEM 组。TEM 组中，肿瘤侵犯深度 pT1sm3 及/或脉管侵犯和/或低分化的患者行 TME 术式。如果 TME 术式为挽救性手术，则排除该患者进行进一步分析。
2011 年 10 月至 2019 年 8 月期间，共纳入 156 例直肠腺癌 pT1 患者（TEM 组 102 例，TME 组 54 例）。TEM 组中 10 例患者因挽救性手术而被排除。TEM 组的手术时间为 40.0（34；50）min，TME 组为 139（120；180）min（=0.00001）。TEM 组的术后住院时间也显著更短（7（6；9）天 vs. 10（7；11）天，=0.00001）。TEM 组有 6（6.5%）例患者和 TME 组有 1（1.8%）例患者发生盆腔局部复发（=0.1）。无远处转移。TEM 组和 TME 组的 3 年无病生存率分别为 92%和 96%（=0.058）。
TEM 是治疗早期直肠癌的一种较为安全的 TME 术式替代方法。
