Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
Int J Surg. 2024 Feb 1;110(2):709-720. doi: 10.1097/JS9.0000000000000945.
With the optimization of neoadjuvant treatment regimens, the indications for intersphincteric resection (ISR) have expanded. However, limitations such as unclear surgical field, impaired anal function, and failure of anal preservation still exist. Transanal total mesorectal excision can complement the drawbacks of ISR. Therefore, this study combined these two techniques and proposed transanal endoscopic intersphincteric resection (taE-ISR), aiming to explore the value of this novel technique in anal preservation for ultra-low rectal cancer.
Four high-volume centres were involved. After 1:1 propensity score-matching, patients with ultra-low rectal cancer underwent taE-ISR ( n =90) or ISR ( n =90) were included. Baseline characteristics, perioperative outcomes, pathological results, and follow-up were compared between the two groups. A nomogram model was established to assess the potential risks of anal preservation.
The incidence of adjacent organ injury (0.0% vs. 5.6%, P =0.059), positive distal resection margin (1.1% vs. 8.9%, P =0.034), and incomplete specimen (2.2% vs. 13.3%, P =0.012) were lower in taE-ISR group. Moreover, the anal preservation rate was significantly higher in taE-ISR group (97.8% vs. 82.2%, P =0.001). Patients in the taE-ISR group showed a better disease-free survival ( P =0.044) and lower cumulative recurrence ( P =0.022) compared to the ISR group. Surgery procedure, tumour distance, and adjacent organ injury were factors influencing anal preservation in patients with ultra-low rectal cancer.
taE-ISR technique was safe, feasible, and improved surgical quality, anal preservation rate and survival outcomes in ultra-low rectal cancer patients. It held significant clinical value and showed promising application prospects for anal preservation.
随着新辅助治疗方案的优化，括约肌间切除术（ISR）的适应证有所扩大。然而，仍存在手术视野不清晰、肛门功能受损以及保肛失败等局限性。经肛门全直肠系膜切除术可以弥补 ISR 的不足。因此，本研究结合这两种技术，提出经肛门内镜括约肌间切除术（taE-ISR），旨在探讨该新技术在超低位直肠癌保肛中的应用价值。
本研究纳入了 4 家高容量中心的患者。经过 1:1 倾向评分匹配后，将接受 taE-ISR（n=90）或 ISR（n=90）治疗的超低位直肠癌患者纳入研究。比较两组患者的基线特征、围手术期结局、病理结果和随访情况。建立列线图模型评估保肛的潜在风险。
taE-ISR 组的邻近器官损伤发生率（0.0% vs. 5.6%，P=0.059）、远端切缘阳性率（1.1% vs. 8.9%，P=0.034）和不完整标本率（2.2% vs. 13.3%，P=0.012）较低。此外，taE-ISR 组的保肛率显著更高（97.8% vs. 82.2%，P=0.001）。与 ISR 组相比，taE-ISR 组的无病生存率更高（P=0.044），累积复发率更低（P=0.022）。手术方式、肿瘤距离和邻近器官损伤是影响超低位直肠癌患者保肛的因素。
taE-ISR 技术安全、可行，可提高超低位直肠癌患者的手术质量、保肛率和生存结局，具有显著的临床价值，为保肛提供了有前景的应用前景。
