Xu Zhi-Wen, Zhu Jing-Tao, Bai Hao-Yu, Yu Xue-Jun, Hong Qing-Qi, You Jun
Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):933-944. doi: 10.4251/wjgo.v16.i3.933.
Transanal endoscopic intersphincteric resection (ISR) surgery currently lacks sufficient clinical research and reporting.
To investigate the clinical effectiveness of transanal endoscopic ISR, in order to promote the clinical application and development of this technique.
This study utilized a retrospective case series design. Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included. All patients underwent transanal endoscopic ISR as the surgical approach. We conducted this study to determine the perioperative recovery status, postoperative complications, and pathological specimen characteristics of this group of patients.
This study included 45 eligible patients, with no perioperative mortalities. The overall incidence of early complications was 22.22%, with a rate of 4.44% for Clavien-Dindo grade ≥ III events. Two patients (4.4%) developed anastomotic leakage after surgery, including one case of grade A and one case of grade B. Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients. The mean distance between the tumor lower margin and distal resection margin was found to be 2.30 ± 0.62 cm. The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens.
Transanal endoscopic ISR is safe, feasible, and provides a clear anatomical view. It is associated with a low incidence of postoperative complications and favorable pathological outcomes, making it worth further research and application.
经肛门内镜括约肌间切除术（ISR）目前缺乏充分的临床研究和报道。
探讨经肛门内镜ISR的临床疗效，以促进该技术的临床应用和发展。
本研究采用回顾性病例系列设计。纳入2018年5月至2023年5月在厦门大学附属第一医院接受经肛门内镜ISR的低位直肠癌患者的临床和病理资料。所有患者均采用经肛门内镜ISR作为手术方式。我们进行本研究以确定该组患者的围手术期恢复情况、术后并发症及病理标本特征。
本研究纳入45例符合条件的患者，围手术期无死亡病例。早期并发症的总体发生率为22.22%，Clavien-Dindo≥Ⅲ级事件发生率为4.44%。2例患者（4.4%）术后发生吻合口漏，其中A级1例，B级1例。术后病理检查证实所有患者环周切缘和远端切缘均为阴性。肿瘤下缘与远端切缘的平均距离为2.30±0.62 cm。经肛门内镜ISR手术始终能获得高质量的病理标本。
经肛门内镜ISR安全、可行，能提供清晰的解剖视野。其术后并发症发生率低，病理结果良好，值得进一步研究和应用。
