Zammit Andrew P, Brown Ian, Hooper John D, Clark David A, Riddell Andrew D
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Envoi Specialist Pathologists, Brisbane, Queensland, Australia.
ANZ J Surg. 2022 Nov;92(11):2949-2955. doi: 10.1111/ans.17917. Epub 2022 Jul 18.
Rectal malignant polyps can be managed by use of trans-anal resections (TAR). Traditional techniques of resection have been replaced by use of platforms such as trans-anal minimally invasive surgery (TAMIS) or trans-anal endoscopic microsurgery (TEM). This study reviewed the management of rectal malignant polyps, in particular focussing on when clinicians used TAR.
A population wide cohort study of all malignant rectal polyps diagnosed in Queensland, Australia from 2011 to 2018 was undertaken. Patient and pathological factors were compared across the management strategies of polypectomy, TAR and rectal resection.
Overall 430 patients were diagnosed with a malignant rectal polyp during the study period, with 103 undergoing a TAR. There was increasing use of TAR across the study period as a management strategy (P < 0.001). Polypectomy alone was more likely to be the management strategy over TAR or rectal resection if there were clear margins (P < 0.001). The distance to the closest polypectomy margin was also significantly higher in the polypectomy group with mean clearance 2.09 mm in polypectomy group versus 0.86 mm in TAR group and 0.99 mm in resection group (P < 0.001). Rectal resection was more likely to be the management strategy over TAR if there was LVI (P < 0.001), depth of invasion was deeper (P < 0.001) and there was tumour budding (P = 0.001).
TAR is an effective management strategy for rectal polyps and is utilized particularly in rectal malignant polyps when there are close or involved margins. Future guideline development should consider incorporation of TAR given the advances in techniques afforded by TAMIS or TEM platforms.
直肠恶性息肉可通过经肛门切除术（TAR）进行治疗。传统的切除技术已被经肛门微创手术（TAMIS）或经肛门内镜显微手术（TEM）等平台所取代。本研究回顾了直肠恶性息肉的治疗情况，尤其关注临床医生何时使用TAR。
对2011年至2018年在澳大利亚昆士兰州诊断出的所有直肠恶性息肉进行了一项全人群队列研究。比较了息肉切除术、TAR和直肠切除术等治疗策略下的患者和病理因素。
在研究期间，共有430例患者被诊断为直肠恶性息肉，其中103例接受了TAR。在整个研究期间，TAR作为一种治疗策略的使用频率有所增加（P<0.001）。如果切缘清晰，单纯息肉切除术比TAR或直肠切除术更有可能成为治疗策略（P<0.001）。息肉切除术组到最近切缘的距离也显著更高，息肉切除术组的平均切缘清除率为2.09毫米，而TAR组为0.86毫米，切除组为0.99毫米（P<0.001）。如果存在淋巴管浸润（LVI）（P<0.001）、浸润深度更深（P<0.001）且有肿瘤芽生（P=0.001），直肠切除术比TAR更有可能成为治疗策略。
TAR是直肠息肉的一种有效治疗策略，尤其在切缘接近或受累的直肠恶性息肉中使用。鉴于TAMIS或TEM平台技术的进步，未来指南的制定应考虑纳入TAR。
