Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan.
Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.
Langenbecks Arch Surg. 2024 Oct 4;409(1):297. doi: 10.1007/s00423-024-03493-8.
Transperineal minimally invasive surgery (TpMIS) during laparoscopic abdominoperineal resection (APR) is an emerging approach that allows for the precise treatment of lower rectal cancer. However, evidence regarding the efficacy of TpMIS is insufficient. This study evaluated the efficacy of TpMIS during laparoscopic APR for patients with lower rectal cancer.
Patients who underwent laparoscopic APR with TpMIS (TpMIS group; n = 12) and those who underwent conventional laparoscopic APR for low rectal cancer (conventional group; n = 13) were enrolled consecutively in this retrospective study. Standardized TpMIS was performed at our institution. Patient and tumor characteristics and intraoperative, postoperative, and pathological outcomes were compared between groups. The primary outcome was postoperative perineal wound infection.
No patients in the TpMIS group experienced postoperative perineal wound infection; however, five (38.5%) patients in the conventional group experienced postoperative perineal wound infection (significant difference; p = 0.016). The estimated blood loss (median, 81 mL vs. 463 mL) and incidence of postoperative urinary dysfunction (8.3% vs. 46.1%) were significantly lower in the TpMIS group than in the conventional group. The postoperative hospital stay (median, 13 vs. 20 days) of the TpMIS group was significantly shorter than that of the conventional group. Pathological outcomes did not differ between groups. The positive circumferential resection margin rates of the TpMIS and conventional groups were 8.3% and 15.4%, respectively.
TpMIS during laparoscopic APR was associated with significant improvements in the postoperative outcomes of patients with low rectal cancer.
经会阴微创腹腔镜腹会阴联合切除术（TpMIS）是一种新兴的方法，可实现对低位直肠癌的精准治疗。然而，目前关于 TpMIS 疗效的证据还不够充分。本研究评估了 TpMIS 在腹腔镜 APR 治疗低位直肠癌患者中的疗效。
本回顾性研究连续纳入了接受 TpMIS 辅助腹腔镜 APR（TpMIS 组，n=12）和接受常规腹腔镜 APR 治疗低位直肠癌的患者（常规组，n=13）。在本机构实施标准 TpMIS。比较两组患者的一般资料、肿瘤特征及术中、术后和病理结果。主要结局为术后会阴伤口感染。
TpMIS 组无一例患者发生术后会阴伤口感染，而常规组有 5 例（38.5%）患者发生术后会阴伤口感染（差异有统计学意义，p=0.016）。TpMIS 组的估计出血量（中位数 81 ml 比 463 ml）和术后尿功能障碍发生率（8.3%比 46.1%）显著低于常规组。TpMIS 组的术后住院时间（中位数 13 天比 20 天）显著短于常规组。两组的病理结果无差异。TpMIS 组和常规组的阳性环周切缘率分别为 8.3%和 15.4%。
TpMIS 辅助腹腔镜 APR 可显著改善低位直肠癌患者的术后结局。
