Miyasaka Mamoru, Kitashiro Shuji, Okushiba Shunichi, Sumiyoshi Tetsuya, Takeda Hiroko, Hirano Satoshi
Department of Surgery, Tonan Hospital, Japan.
Department of Surgery, Tonan Hospital, Japan.
Int J Surg Case Rep. 2022 Sep;98:107590. doi: 10.1016/j.ijscr.2022.107590. Epub 2022 Sep 2.
Endoscopic submucosal dissection (ESD) for colorectal cancer is challenging but is gradually being performed worldwide. It is less invasive than surgical resection and can be performed on lesions in which malignancy cannot be diagnosed. In low rectal cancers, changes such as scarring after ESD may make it challenging to preserve the anus when additional surgical resection is required. Transanal total mesorectal excision (TaTME) is a novel surgical technique involving transanal endoscopic manipulation. It is useful for lesions in the deep pelvis near the anus. Herein, we report six cases of TaTME after ESD for early-stage low rectal cancer that resulted in incomplete resection. As a representative case, a 77-year-old female was referred to our hospital, and colonoscopy revealed low rectal cancer. ESD was performed, and the pathological diagnosis was an invasion of the submucosal layer and microscopic lymphovascular invasion. We performed an additional laparoscopic low anterior resection with TaTME. Lymph node metastasis was observed, and the final diagnosis was pT1b, pN1a, pStage IIIa, and R0. In other cases, the anus can also be preserved, and the distal margin can be secured. TaTME enabled anal preservation without being affected by the ESD scars. It is considered useful for additional resection after ESD of low rectal cancer.
结直肠癌的内镜下黏膜剥离术（ESD）具有挑战性，但目前正在全球范围内逐渐开展。它比手术切除的侵入性小，并且可用于无法诊断为恶性肿瘤的病变。在低位直肠癌中，ESD术后的瘢痕等改变可能会使在需要额外手术切除时保留肛门变得具有挑战性。经肛门全直肠系膜切除术（TaTME）是一种涉及经肛门内镜操作的新型手术技术。它对肛门附近深盆腔内的病变有用。在此，我们报告6例早期低位直肠癌ESD术后TaTME导致切除不完全的病例。作为一个典型病例，一名77岁女性被转诊至我院，结肠镜检查发现低位直肠癌。实施了ESD，病理诊断为黏膜下层侵犯及微小淋巴管侵犯。我们又进行了一次TaTME辅助的腹腔镜低位前切除术。观察到有淋巴结转移，最终诊断为pT1b、pN1a、pⅢa期和R0。在其他病例中，也可保留肛门并确保切缘阴性。TaTME能够在不受ESD瘢痕影响的情况下保留肛门。它被认为对低位直肠癌ESD术后的额外切除有用。
