Section of Colorectal Surgery, Department of Surgery, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA.
Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
Langenbecks Arch Surg. 2023 Jun 30;408(1):257. doi: 10.1007/s00423-023-02981-7.
The aim of this study was to evaluate whether the visceral fat area (VFA) has an impact on the histopathology specimen metrics of male patients undergoing robotic total mesorectal resection (rTME) for distal rectal cancer.
Prospectively collected data of patients undergoing rTME for resectable rectal cancer by five surgeons during a period of three years were extracted from the REgistry of Robotic SURgery for RECTal cancer (RESURRECT). VFA was measured in all patients at preoperative computed tomography. Distal rectal cancer was defined as <6cm from the anal verge. The histopathology metrics included circumferential resection margin (CRM) (in mm) and its involvement rate (if <1mm), distal resection margin (DRM), and quality of TME (complete, nearly-complete, incomplete).
Of 839 patients who underwent rTME, 500 with distal rectal cancer were included. One hundred and six (21.2%) males with VFA>100cm were compared to 394 (78.8%) males or females with VFA≤100cm. The mean CRM of males with VFA>100cm was not significantly different from its counterpart (6.6 ± 4.8 mm versus 7.1 ± 9.5mm; p=0.752). CRM involvement rates were 7.6% in both groups (p=1.000). The DRM was not significantly different: 1.8±1.9cm versus 1.8±2.6cm; p=0.996. The quality of TME did not significantly differ: complete TME 87.3% vs. 83.7%; nearly complete TME 8.9% vs. 12.8%; incomplete TME 3.8% vs. 3.6%. Complications and clinical outcomes did not significantly differ.
This study did not find evidence to support that increased VFA would result in suboptimal histopathology specimen metrics when performing rTME in males with distal rectal cancer.
本研究旨在评估男性患者接受机器人全直肠系膜切除术（rTME）治疗低位直肠癌时，内脏脂肪面积（VFA）是否会影响其组织病理学标本指标。
从直肠机器人手术治疗直肠癌登记处（RESURRECT）中提取了 5 位外科医生在三年内对可切除直肠癌患者进行 rTME 的前瞻性收集数据。所有患者在术前 CT 上测量 VFA。低位直肠癌定义为距肛门 6cm 以内。组织病理学指标包括环周切缘（CRM）（mm）及其受累率（如果<1mm）、远端切缘（DRM）和 TME 质量（完全、接近完全、不完全）。
在 839 例接受 rTME 的患者中，纳入了 500 例低位直肠癌患者。106 例（21.2%）VFA>100cm 的男性与 394 例（78.8%）VFA≤100cm 的男性或女性进行比较。VFA>100cm 的男性的 CRM 平均值与对照组无显著差异（6.6±4.8mm 与 7.1±9.5mm；p=0.752）。两组 CRM 受累率均为 7.6%（p=1.000）。DRM 无显著差异：1.8±1.9cm 与 1.8±2.6cm；p=0.996。TME 质量无显著差异：完全 TME 87.3%比 83.7%；接近完全 TME 8.9%比 12.8%；不完全 TME 3.8%比 3.6%。并发症和临床结果无显著差异。
本研究未发现证据支持在男性低位直肠癌患者中，VFA 增加会导致 rTME 组织病理学标本指标不理想。
