Shioi Ikuma, Shiraishi Takuya, Shimizu Yutaro, Uehara Kosei, Seki Takahiro, Hosoi Nobuhiro, Tateno Kouhei, Endo Mizuki, Uchida Shintaro, Yamaguchi Arisa, Katayama Chika, Shibasaki Yuta, Komine Chika, Osone Katsuya, Okada Takuhisa, Kimura Akiharu, Sano Akihiko, Sakai Makoto, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Tech Coloproctol. 2025 May 23;29(1):120. doi: 10.1007/s10151-025-03158-8.
The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.
This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).
In total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.
Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.
对于侵犯相邻结构的晚期或复发性直肠癌，最佳手术方式仍存在争议。本研究旨在阐明腹腔镜双团队经肛门扩大全直肠系膜切除术在侵犯性晚期和复发性直肠癌患者中的可行性。
本单中心回顾性研究于2014年1月至2024年3月在日本一家教学医院进行。纳入接受腹腔镜或双团队经肛门全直肠系膜切除术并切除相邻结构的晚期或复发性直肠癌患者进行分析。比较腹腔镜和经肛门手术方式的短期结局。使用一个新指标“工作人员耗时（STC = 参与工作人员中位数×手术时间）”评估医疗资源负担。
共纳入35例患者。经肛门手术方式的患者更多接受了术前治疗和侧方淋巴结清扫。然而，经肛门组的手术时间（腹腔镜组和经肛门组分别为539分钟和339分钟；p < 0.001）和总失血量（分别为274毫升和70毫升；p = 0.008）更低。此外，经肛门组的切缘阳性率低于腹腔镜组（分别为28%和0%，p = 0.021）；两组的STC相当。术后死亡率和发病率均未增加。手术困难的患者在经肛门组的手术时间更短，且STC相当。
对于经过严格筛选的患者，腹腔镜双团队经肛门手术方式比传统手术方式具有更好的短期结局。
