经肛门全直肠系膜切除术联合延迟性结肠肛管吻合术（TaTME-DCAA）与腹腔镜全直肠系膜切除术（LTME）和机器人全直肠系膜切除术（RTME）治疗低位直肠癌的短期疗效、肠功能和成本的倾向评分匹配分析。

Transanal Total Mesorectal Excision With Delayed Coloanal Anastomosis (TaTME-DCAA) Versus Laparoscopic Total Mesorectal Excision (LTME) and Robotic Total Mesorectal Excision (RTME) for Low Rectal Cancer: A Propensity Score-Matched Analysis of Short-term Outcomes, Bowel Function, and Cost.

机构信息

Department of Colorectal Surgery, Singapore General Hospital.

Group Finance Analytics, Singapore Health Services, Singapore.

出版信息

Surg Laparosc Endosc Percutan Tech. 2024 Feb 1;34(1):54-61. doi: 10.1097/SLE.0000000000001247.

DOI:10.1097/SLE.0000000000001247

PMID:37987634

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10829900/

Abstract

INTRODUCTION

Total mesorectal excision (TME) with delayed coloanal anastomosis (DCAA) is surgical option for low rectal cancer, replacing conventional immediate coloanal anastomosis (ICAA) with bowel diversion. This study aimed to assess the outcomes of transanal TME (TaTME) with DCAA versus laparoscopic TME (LTME) with ICAA versus robotic TME (RTME) with ICAA.

METHODS

This was a retrospective propensity score-matched analysis of patients who underwent elective TaTME-DCAA between November 2021 and June 2022. Patients were propensity-score matched in a ratio of 1:3 to patients who underwent LTME-ICAA and RTME-ICAA from January 2019 to December 2020. Outcome measures were histopathologic results, postoperative morbidity, function, and inpatient costs.

RESULTS

Twelve patients in the TaTME-DCAA group were compared with 36 patients in the LTME-ICAA and RTME-ICAA groups each after propensity score matching. Histopathologic results and postoperative morbidity rates were statistically similar. Overall stoma-related complication rates in the ICAA groups were 11%. Median total length of hospital stays for TME plus stoma reversal surgery was similar across all techniques (10 vs. 10 vs. 9 days; P =0.532). Despite a significantly shorter duration of follow-up, bowel function after TaTME-DCAA was comparable to that of LTME-ICAA and RTME-ICAA. Overall median inpatient costs of TaTME-DCAA were comparable to LTME-ICAA and significantly cheaper than RTME-ICAA ($31,087 vs. $29,927 vs. $36,750; P =0.002).

CONCLUSIONS

TaTME with DCAA is a feasible and safe technique compared with other minimally invasive methods of TME, while avoiding bowel diversion and stoma-related complications, as well as comparing favorably in terms of overall hospitalization costs.

摘要

简介

全直肠系膜切除术（TME）联合延迟性结肠肛管吻合术（DCAA）是低位直肠癌的一种手术选择，用肠造口术替代常规的即刻结肠肛管吻合术（ICAA）。本研究旨在评估经肛门 TME（TaTME）联合 DCAA 与腹腔镜 TME（LTME）联合 ICAA 与机器人 TME（RTME）联合 ICAA 的治疗结果。

方法

这是一项回顾性倾向评分匹配分析，纳入了 2021 年 11 月至 2022 年 6 月期间接受择期 TaTME-DCAA 的患者。根据倾向评分，将患者与 2019 年 1 月至 2020 年 12 月期间接受 LTME-ICAA 和 RTME-ICAA 的患者以 1:3 的比例进行匹配。主要观察指标为组织病理学结果、术后发病率、功能和住院费用。

结果

在 TaTME-DCAA 组中，12 例患者与匹配后的 LTME-ICAA 和 RTME-ICAA 组的 36 例患者进行了比较。组织病理学结果和术后发病率在统计学上相似。ICAA 组总的造口相关并发症发生率为 11%。所有技术的 TME 加造口还纳手术的总住院时间中位数相似（10 天 vs. 10 天 vs. 9 天；P =0.532）。尽管随访时间明显缩短，但 TaTME-DCAA 后的肠功能与 LTME-ICAA 和 RTME-ICAA 相当。TaTME-DCAA 的总住院费用中位数与 LTME-ICAA 相当，明显低于 RTME-ICAA（31087 美元 vs. 29927 美元 vs. 36750 美元；P =0.002）。