Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Int J Colorectal Dis. 2022 Sep;37(9):1975-1982. doi: 10.1007/s00384-022-04233-4. Epub 2022 Aug 9.
Rectal gastrointestinal stromal tumors (GISTs) surgery is often challenging owing to the anatomical constraints of the narrow pelvis and tumor hugeness. Despite the increasing number of patients undergoing trans-anal total mesorectal excision (taTME) globally, the feasibility of trans-anal surgery with the taTME technique for rectal GISTs remains unclear. We aimed to evaluate the feasibility of trans-anal surgery with the taTME technique for rectal GISTs.
Using a prospectively collected database, we retrospectively analyzed the clinical findings, surgical outcomes, pathological outcomes, urinary and anal functions, and prognoses of patients who underwent trans-anal surgery with the taTME technique for primary rectal GISTs at the National Cancer Center Hospital East from September 2014 to March 2020.
Twenty-one patients with primary rectal GISTs were included in this study. The median distance from the anal verge to the lower edge of the tumor was 40 mm (range, 15-60 mm), and the median tumor size was 59 mm (range, 11-175 mm). Moreover, seven and 14 patients underwent one-team and two-team surgeries, respectively, with curative intent. Nineteen patients (90.5%) underwent anus-preserving surgery, and the urinary tracts were preserved in all cases. Two-team surgery showed a significantly lower blood loss volume and shorter operation time than one-team surgery (58 vs. 222 mL, P = 0.017; 184 vs 356 min, P = 0.041, respectively). The pathological negative-margin resection rate was 100%. During the follow-up period, no patient developed local GIST recurrence and one (4.8%) developed distant metastasis.
Trans-anal surgery with the taTME technique is feasible for rectal GISTs, and two-team surgery may be more advantageous than one-team surgery in terms of operation time and blood loss.
由于骨盆狭窄和肿瘤巨大的解剖限制，直肠胃肠道间质瘤（GIST）的手术常常具有挑战性。尽管全球接受经肛门全直肠系膜切除术（taTME）的患者数量不断增加，但直肠 GIST 采用 taTME 技术进行经肛门手术的可行性尚不清楚。我们旨在评估直肠 GIST 采用 taTME 技术进行经肛门手术的可行性。
使用前瞻性收集的数据库，我们回顾性分析了 2014 年 9 月至 2020 年 3 月期间在国家癌症中心医院东部接受 taTME 技术治疗原发性直肠 GIST 的患者的临床发现、手术结果、病理结果、尿和肛门功能以及预后。
本研究纳入了 21 例原发性直肠 GIST 患者。肛门缘至肿瘤下缘的中位距离为 40mm（范围，15-60mm），肿瘤大小的中位值为 59mm（范围，11-175mm）。此外，分别有 7 例和 14 例患者为了治愈目的接受了一队和两队手术。19 例（90.5%）患者行保肛手术，所有病例均保留了泌尿系统。两队手术的出血量和手术时间均明显低于一队手术（58 比 222ml，P=0.017；184 比 356min，P=0.041）。病理切缘阴性的切除率为 100%。在随访期间，无患者出现局部 GIST 复发，1 例（4.8%）患者发生远处转移。
直肠 GIST 采用 taTME 技术进行经肛门手术是可行的，且两队手术在手术时间和出血量方面可能优于一队手术。
