Matsuda Takeru, Yamashita Kimihiro, Hasegawa Hiroshi, Sawada Ryuichiro, Koterazawa Yasufumi, Harada Hitoshi, Urakawa Naoki, Goto Hironobu, Kanaji Shingo, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7 - 5- 2 Kusunoki-Chou, Chuo-Ku, Kobe, 650 - 0017, Japan.
Surg Today. 2025 Apr 8. doi: 10.1007/s00595-025-03042-w.
To examine the clinical impact of transanal total mesorectal excision (TaTME) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy (NACRT).
This retrospective study included 91 patients undergoing surgery for rectal cancer after NACRT between 2011 and 2022. Among them, 24, 22, and 45 patients underwent open (Open), conventional laparoscopic (Lap), and TaTME surgeries, respectively. We compared their clinical outcomes.
Operative time, blood loss, transfusion, morbidity, and hospital stay were significantly lower in the TaTME group than in the Open or Lap groups. The multivariate regression analyses identified only the TaTME approach as a significant factor for reducing morbidity. Both 3 yrear relapse-free survival (RFS) and local recurrence-free survival (LRFS) were significantly better in the TaTME group than in the Open or Lap groups (3 yr RFS: 94.7%, 80.4%, and 66.7%, and 3 yr LRFS: 100%, 90.5%, and 82.2% for the TaTME, Lap, and Open groups, respectively). Multivariate analyses of potential risk factors for recurrence identified body mass index, combined resection, and pathological stage, but not the TaTME approach, as significant predictors of recurrence.
TaTME reduced morbidity significantly in patients with locally advanced rectal cancer undergoing NACRT, compared with open or laparoscopic surgery.
探讨新辅助放化疗（NACRT）后经肛门全直肠系膜切除术（TaTME）治疗局部进展期直肠癌的临床疗效。
本回顾性研究纳入了2011年至2022年间接受NACRT后行直肠癌手术的91例患者。其中，分别有24例、22例和45例患者接受了开放手术（Open）、传统腹腔镜手术（Lap）和TaTME手术。我们比较了它们的临床结局。
TaTME组的手术时间、失血量、输血量、发病率和住院时间均显著低于开放手术组或腹腔镜手术组。多因素回归分析显示，只有TaTME手术方式是降低发病率的显著因素。TaTME组的3年无复发生存率（RFS）和局部无复发生存率（LRFS）均显著优于开放手术组或腹腔镜手术组（TaTME组、腹腔镜手术组和开放手术组的3年RFS分别为94.7%、80.4%和66.7%，3年LRFS分别为100%、90.5%和82.2%）。对复发潜在危险因素的多因素分析确定，体重指数、联合切除和病理分期是复发的显著预测因素，但TaTME手术方式不是。
与开放手术或腹腔镜手术相比，TaTME显著降低了接受NACRT的局部进展期直肠癌患者的发病率。
