Abstract：Objective To investigate the safety and short-term clinical efficacy of laparoscopically assisted transanal total mesorectal resection (Lap-TaTME) in the anal-preserving radical resection of low rectal cancer. Methods In this retrospective cohort study, the clinical data of 85 patients who underwent the radical resection of low rectal cancer at the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Bengbu Medical College from April 2019 to August 2020 were included. Of the 85 patients, 52 were males, and 33 were females, and their age range was 40-74 years. The patients were divided into two groups according to different surgical methods: the Lap-TaTME group (31 patients) and the laparoscopically assisted total mesorectal resection (Lap-TME) group (54 patients). The following observation indicators were obtained and compared: baseline data, perioperative indicators, pathological indicators, anus preservation rate and surgical transition rate, complications within 30 days after surgery, postoperative anal function Wexner score, postoperative recurrence, and metastasis. Results (1) The comparison of baseline data showed no statistically significant differences in gender, age, BMI, diabetes, hypertension, smoking history, tumor stage, and other indicators between the two groups (all P values >0.05). (2) As for the perioperative indicators, the operation time of the Lap-TaTME group was longer than that in the Lap-TME group, the postoperative hospital stay and the first exhaust time of the Lap-TaTME group were significantly shorter than those of the Lap-TME group (t=2.19, 3.26, 4.426; all P values <0.05). Their intraoperative blood loss, preventive stoma, and other indicators had no statistically significant differences (all P values >0.05). (3) In terms of the pathological indicators, the tumor diameter, the distance between the inferior resection margin and the anal margin, the number of lymph nodes, the positive inferior resection margin of the tumor, the positive circumferential resection margin, and the degree of differentiation did not significantly differ between the two groups (all P values >0.05). (4) The anus preservation rate and operation transition rate of the two groups were not significantly different (all P values >0.05). (5) The incidences of complications within 30 days after operation were 12.90%(4/31) in the Lap-TaTME group and 11.11%(6/54) in the Lap-TME group. These values had no significant differences (χ2=7.92, P=0.244). (6) The Wexner score of anal function 1 week before operation and 12 months after operation did not significantly differ (all P values >0.05); Wexner scores of anal function in the Lap-TATME group were (8.6±2.1) and (10.0±2.1) points at 3 and 6 months after surgery, which were significantly higher than those in the Lap-TME group (6.4±1.4) and (7.8±1.9) points (t=2.77, P=0.007; t=3.55, P<0.001). (7) All patients were followed up to monitor recurrence and metastasis (12-16 months). During this period, one case in the Lap-TME group had local recurrence and no distant metastasis. Conversely, the cases in the Lap-TaTME group did not have local recurrence or metastasis. Conclusion Lap-TaTME is safe during the anal-preserving radical resection of low rectal cancer and has a quick postoperative recovery. Its short-term clinical effect is clear.
葛思堂, 邱权威, 郝博, 左芦根, 刘牧林. 腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌保肛根治术中的应用研究[J]. 中华解剖与临床杂志, 2022, 27(2): 92-97.
Ge Sitang, Qiu Quanwei, Hao Bo, Zuo Lugen, Liu Mulin. Application of laparoscopically assisted transanal total mesorectal excision in the anal-preserving radical resection of low rectal cancer. Chinese Journal of Anatomy and Clinics, 2022, 27(2): 92-97.
温贺新, 史维俊, 葛思堂, 等. 6种蛋白质构建的预测模型在结直肠癌预后预测中的作用:基于TCPA数据库[J].南方医科大学学报, 2021,41(3):439-446. DOI: 10.12122/j.issn.1673-4254.2021.03.18.Wen HX, Shi WJ, Ge ST, et al.Value of prediction models for prognosis prediction of colorectal cancer: an analysis based on TCPA database[J]. J South Med Univ, 2021, 41(3):439-446. DOI: 10.12122/j.issn.1673-4254.2021.03.18.
姚宏伟, 张忠涛. 精准医学在结直肠癌诊治中的共识与争议[J].中国实用外科杂志, 2018, 38(1):68-71. DOI: 10.19538/j.cjps.issn1005-2208.2018.01.14.Yao HW, Zhang ZT.The progress and controversy on precision medicine of colorectal cancer[J]. Chinese Journal of Practical Surgery, 2018,38(1):68-71. DOI: 10.19538/j.cjps.issn1005-2208.2018.01.14.
[5]
左芦根, 葛思堂, 王迅, 等. 腹腔镜直肠癌保肛根治术后低位前切除综合征的转归及其影响因素分析[J].中华胃肠外科杂志, 2019, 22(6):573-578. DOI: 10.3760/cma.j.issn.1671-0274.2019.06.011.Zuo LG, Ge ST, Wang X, et al.Analysis on prognosis and influencing factors of postoperative low anterior resection syndrome for rectal cancer patients undergoing laparoscopic anus-preserving radical resection[J].Chin J Gastrointest Surg,2019,22(6):573-578. DOI: 10.3760/cma.j.issn.1671-0274.2019.06.011.
Rubinkiewicz M, Nowakowski M, Wierdak M, et al.Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME[J]. Cancer Manag Res, 2018,10:5239-5245. DOI: 10.2147/CMAR.S181214.
[8]
De Rosa M, Rondelli F, Boni M, et al.Transanal total mesorectal excision (TaTME): single-centre early experience in a selected population[J]. Updates Surg, 2019,71(1):157-163. DOI: 10.1007/s13304-018-0602-9.
[9]
Miskovic D, Ahmed J, Bissett-Amess R, et al.European consensus on the standardization of robotic total mesorectal excision for rectal cancer[J]. Colorectal Dis, 2019,21(3):270-276. DOI: 10.1111/codi.14502.
[10]
Larsen SG, Pfeffer F, Kørner H.Norwegian moratorium on transanal total mesorectal excision[J]. Br J Surg, 2019,106(9):1120-1121. DOI: 10.1002/bjs.11287.
[11]
Jorge JM, Wexner SD.Etiology and management of fecal incontincnce[J]. Dis Colon Rectum, 1993, 36(1): 77-97.
[12]
Abdelkader AM, Zidan AM, Younis MT, et al.Transanal total mesorectal excision for treatment of carcinoma in the middle or lower third rectum: the technical feasibility of the procedure, pathological results, and clinical outcome[J]. Indian J Surg Oncol, 2018,9(4):442-451. DOI: 10.1007/s13193-018-0808-9.
[13]
Kwak JM, Romagnolo L, Wijsmuller A, et al.Stereotactic pelvic navigation with augmented reality for transanal total mesorectal excision[J]. Dis Colon Rectum, 2019,62(1):123-129. DOI: 10.1097/DCR.0000000000001259.
[14]
Ye J, Tian Y, Li F, et al.Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: a case matched study[J]. Eur J Surg Oncol, 2021, 47(5):1019-1025. DOI: 10.1016/j.ejso.2020.11.131.
[15]
罗双灵, 蔡永华, 张兴伟, 等. 经肛门与腹腔镜全直肠系膜切除术治疗直肠癌的疗效分析[J].中华消化外科杂志, 2017,16(7):703-708. DOI: 10.3760/cma.j.issn.1673-9752.2017.07.013.Luo SL, Cai YH, Zhang XW, et al.Efficacies of transanal total mesorectal excision and laparoscopic total mesorectal excision for rectal cancer[J].Chin J Dig Surg,2017,16(7):703-708. DOI: 10.3760/cma.j.issn.1673-9752.2017.07.013.
[16]
姚宏伟, 陈建志, 张宏宇, 等. 中国经肛全直肠系膜切除手术病例登记协作研究数据库2018年度报告:一项全国性登记研究[J]. 中国实用外科杂志, 2019, 39(1):85-91. DOI: 10.19538/j.cjps.issn1005-2208.2019.01.15.Yao HW, Chen JZ, Zhang HY, et al.Annual report of Chinese Transanal Total Mesorectal Excision Registry Collaborative in 2018: a nationwide registry study[J]. Chinese Journal of Practical Surgery, 2019, 39(1):85-91. DOI: 10.19538/j.cjps.issn1005-2208.2019.01.15.
Penna M, Hompes R, Arnold S, et al.Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international tatme registry[J]. Ann Surg, 2019, 269(4):700-711. DOI: 10.1097/SLA.0000000000002653.
[19]
磨鹏诗, 杨平, 陈应驹. 腹腔镜辅助TaTME术在低位直肠癌患者中的临床效果及安全性研究[J].中华普外科手术学杂志(电子版), 2019, 13(2):155-158. DOI: 10.3877/cma.j.issn.1674-3946.2019.02.015.Mo PS, Yang P, Chen YJ.Clinical outcome and safety analysis of laparoscopic assisted TaTME for patients with low rectal cancer[J]. Chin J Oper Proc Gen Surg(Electronic Edition), 2019,13(2):155-158. DOI: 10.3877/cma.j.issn.1674-3946.2019.02.015.
2022, Vol. 27 
