经肛门全直肠系膜切除术（taTME）在生活质量和功能结局方面是否比传统全直肠系膜切除术（TME）更好？一项倾向评分调整的回顾性队列研究。
Does transanal total mesorectal excision (taTME) result in better quality of life and functional outcomes than traditional TME does? A retrospective propensity score-adjusted cohort study.
作者信息
Ammann Yanic, Klein Marie, Marti Lukas, Warschkow Rene, Ströse Lennard, Sparn Moritz, Jäger Tarkan, Bischofberger Stephan, Brunner Walter
机构信息
Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St.Gallen, Rorschacherstrasse 95, St.Gallen, CH-9007, Switzerland.
Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
出版信息
Langenbecks Arch Surg. 2025 Apr 30;410(1):149. doi: 10.1007/s00423-025-03724-6.
PURPOSE
The improved prognosis of rectal cancer through modern therapeutic approaches raises questions regarding quality of life (QoL) and functional outcomes. In this study, we compared post-transanal total mesorectal excision (taTME) short- and long-term QoL and functional outcomes with those after abdominal TME (abTME).
METHODS
Prospective data from patients who underwent elective taTME or abTME for stage I-III rectal cancer followed by anastomosis were retrospectively propensity score-adjusted. The primary endpoint, QoL, was assessed with the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30). Functional outcomes were the secondary endpoints.
RESULTS
Among 494 patients during 2013-2022, 187 patients who underwent taTME and 62 patients who underwent abTME were included. QoL was worse after taTME at isolated time points: overall QoL (after 3 years: 72 vs. 82 points, p = 0.017) and QLQ-total (after 3 years: 81 vs. 87 points, p = 0.028; after 4 years: 82 vs. 89 points, p = 0.012). After propensity score matching, the between-group differences were still significant but smaller: overall QoL - 6 points, p = 0.021; QLQ-total - 5 points, p = 0.026.
CONCLUSION
The differences reported at isolated time points have questionable clinical relevance. Therefore, taTME and traditional abTME seem to have comparable long-term QoL and functional outcomes.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT06505863, https://clinicaltrials.gov/search?id=NCT06505863 .
目的
现代治疗方法改善了直肠癌的预后，但也引发了关于生活质量（QoL）和功能结局的问题。在本研究中，我们比较了经肛门全直肠系膜切除术（taTME）与腹会阴联合全直肠系膜切除术（abTME）后的短期和长期QoL及功能结局。
方法
对接受I-III期直肠癌择期taTME或abTME并进行吻合术患者的前瞻性数据进行回顾性倾向评分调整。主要终点QoL采用欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）进行评估。功能结局为次要终点。
结果
在2013年至2022年期间的494例患者中，纳入了187例行taTME的患者和62例行abTME的患者。在个别时间点，taTME后的QoL较差：总体QoL（3年后：72分对82分，p = 0.017）和QLQ总分（3年后：81分对87分，p = 0.028；4年后：82分对89分，p = 0.012）。倾向评分匹配后，组间差异仍然显著但较小：总体QoL - 6分，p = 0.021；QLQ总分 - 5分，p = 0.026。
结论
个别时间点报告的差异临床相关性存疑。因此，taTME和传统abTME似乎具有相当的长期QoL和功能结局。
临床试验注册
ClinicalTrials.gov，NCT06505863，https://clinicaltrials.gov/search?id=NCT06505863 。
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