经肛全直肠系膜切除价值及争议

The value and controversy of transanal total mesorectal excision

开展经肛全直肠系膜切除(transanal total mesorectal excision,taTME)的预期是在困难骨盆的中低位直肠癌病人中获得更好的肿瘤学效果。然而这一技术问世10年以来,目前仍然争议不断,争议的内容也从技术安全性延伸至肿瘤的安全性。焦点问题主要包括对实施taTME手术必要性的质疑、taTME是否有环周切缘的优势、taTME是否增加局部复发的风险以及taTME是否增加了手术并发症等。taTME的技术安全性可通过结构化培训获得提高,但目前仍然存在其特有的术中及术后并发症问题。尽管在一些研究中taTME的肿瘤安全性已经取得了非劣效的结果,然而受挪威暂停taTME这一事件的影响而再次备受关注。taTME在伴有困难骨盆的中低位直肠癌中的优势仍有待高质量循证医学证据证实。对于taTME的价值和争议问题须进行客观公正的评价,既不热衷吹捧也不全面否定。

The original intention and expected benefit of transanal total mesorectal excision(taTME)intended is to gain better oncology results in the low and middle rectal cancers with difficult pelvis.But this technology,which has been carried out for a decade,is still in controversy,with issues ranging from technical safety to tumor safety.The focus issues mainly include questions about the necessity of performing taTME surgery,whether taTME has the advantage in the circumferential resection margin,whether taTME increases the risk of local recurrence,and whether taTME increases the complications.TaTME’s technical safety can be improved through structured training,but specific intraoperative and postoperative complications remain.Although the safety of taTME’s tumors has been shown to be non-inferior in some studies,the impact of Norway’s decision to suspend taTME surgery has come under renewed scrutiny.The advantages of taTME in low and middle rectal cancer with a difficult pelvis still await high-quality evidence-based medical evidence.TaTME’s values and controversial issues need to be evaluated objectively and fairly,with neither adulation nor denial.