Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.

Transanal total mesorectal excision: Myths and reality

Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection

BACKGROUND Achieving a clear resection margins for low rectal cancer is technically challenging.Transanal approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal cancers.However,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer difficult.AIM To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal cancer.METHODS A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.Intraoperative and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome measures.RESULTS We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal tumours.TaTME was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with LaTME.Moreover,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to LaTME.More randomised controlled trials are required to confirm these findings and to evaluate long term oncological and functional outcomes.

Robotic transanal total mesorectal excision:Is the future now?

Total mesorectal excision(TME)is the standard surgical treatment for the curative radical resection of rectal cancers.Minimally invasive TME has been gaining ground favored by the continuous technological advancements.New procedures,such as transanal TME(TaTME),have been introduced to overcome some technical limitations,especially in low rectal tumors,obese patients,and/or narrow pelvis.The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME.However,recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series.Robotic TaTME(R-TaTME)has been proposed as a novel technique incorporating the potential benefits of a perineal dissection together with precise control of the distal margins,and also offers all those advantages provided by the robotic technology in terms of improved precision and dexterity.Encouraging short-term results have been reported for R-TaTME,but further studies are needed to assess the real role of the new technique in the long-term oncological or functional outcomes.The present review aims to provide a general overview of R-TaTME by analyzing the body of the available literature,with a special focus on the potential benefits,harms,and future perspectives for this novel approach.

Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer

BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is essential to achieve R0 resection for low rectal cancer in TaTME,is technically demanding.AIM To assess the feasibility of optical biopsy using probe-based confocal laser endomicroscopy(pCLE)to select the DRM during TaTME for low rectal cancer.METHODS A total of 43 consecutive patients who were diagnosed with low rectal cancer and scheduled for TaTME were prospectively enrolled from January 2019 to January 2021.pCLE was used to determine the distal edge of the tumor as well as the DRM during surgery.The final pathological report was used as the gold standard.The diagnostic accuracy of pCLE examination was calculated.RESULTS A total of 86 pCLE videos of 43 patients were included in the analyses.The sensitivity,specificity and accuracy of real-time pCLE examination were 90.00%[95%confidence interval(CI):76.34%-97.21%],86.96%(95%CI:73.74%-95.06%)and 88.37%(95%CI:79.65%-94.28%),respectively.The accuracy of blinded pCLE reinterpretation was 86.05%(95%CI:76.89%-92.58%).Furthermore,our results show satisfactory interobserver agreement(κ=0.767,standard error=0.069)for the detection of cancer tissue by pCLE.There were no positive DRMs(≤1 mm)in this study.The median DRM was 7 mm[interquartile range(IQR)=5-10 mm].The median Wexner score was 5(IQR=3-6)at 6 mo after stoma closure.CONCLUSION Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer(clinical trial registration number:NCT04016948).

Laparoscopic total mesorectal excision with natural orifice specimen extraction

AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.

Transanal vs laparoscopic total mesorectal excision for rectal cancer:a multicenter randomized phase III clinical trial(TaLaR trial)protocol

Background:Total mesorectum excision(TME)is considered the standard surgical procedure for rectal-cancer treatment.Transanal TME(taTME)is a new procedure to treat low rectal cancer.Some published studies have proven that taTME can provide a better-quality resected specimen in low-rectal-cancer patients in comparison to the transabdominal procedure,yet long-term outcomes must be investigated.We designed this non-inferiority trial(TaLaR trial)to compare short-term and long-term outcomes between taTME and laparoscopic TME(lapTME)for rectal cancer.Methods:The TaLaR trial is a phase III open-labeled multicenter randomized-controlled trial.Patients who are diagnosed with rectal cancer with no more than T3N2 stage,and with the tumor location below the peritoneal reflection by magnetic resonance imaging scan,digital rectal examination,or colonoscopy,qualify for this study.After calculating,a total of 1,114 patients(557 per group)will be randomly allocated to either the taTME or the lapTME group.Primary endpoints are the 3-year disease-free survival(DFS)rate and the 5-year overall survival(OS)rate.Secondary endpoints include specimen quality,perioperative results,pelvic and anal function,and quality of life.Discussion:The TaLaR trial is expected to clarify whether taTME can achieve comparable oncological outcomes,as well as improve specimen quality and recovery conditions in rectal-cancer patients compared with lapTME.

Transanal total mesorectal excision for rectal cancer:a multicentric cohort study

Background:Transanal total mesorectal excision(taTME)has recently emerged as a promising novel surgical procedure for rectal cancer.It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results.This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals.Methods:A total of 211 patients were enrolled in this study.Variables for evaluation of safety,feasibility,and oncologic outcomes were retrospectively collected and analysed.Results:The median distance between the tumor and the anal verge was 5.9cm(range,1.5–12 cm).The median operating time was 280 min(range,70–600 min)and the median estimated intra-operative blood loss was 50mL(range,10–1,500 mL).The overall rate of complication was 27.9%.Among the 211 patients,175(82.9%)had complete TME and 33(15.6%)had near complete TME.The circumferential resection margin was negative in 97.7%of patients.The patients were followed for a median of 35months(range,2–86months).There was 7.6%(16)mortality,6.2%(13)had local recurrence,and 12.8%(27)had systemic recurrence.Kaplan–Meier survival analysis showed that 1-,2-,and 3-year disease-free survival rates were 94.8%,89.3%,and 80.2%,respectively,and 1-,2-,and 3-year OS rates were 97.4%,95.7%,and 92.9%,respectively.Conclusions:Although limited by its retrospective nature,taTME was safe and feasible in selected patients.Future work with rigorous data recording is warranted.

Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer

AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.

Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms

Transanal surgery has and continues to be well accepted for local excision of benign rectal disease not amenable to endoscopic resection. More recently, there has been increasing interest in applying transanal surgery to local resection of early malignant disease. In addition, some groups have started utilizing a transanal route in order to accomplish total mesorectal excision(TME) for more advanced rectal malignancies. We aim to review the role of various transanal and endoscopic techniquesin the local resection of benign and malignant rectal disease based on published trial data. Preliminary data on the use of transanal platforms to accomplish TME will also be highlighted. For endoscopically unresectable rectal adenomas, transanal surgery remains a widely accepted method with minimal morbidity that avoids the downsides of a major abdomino-pelvic operation. Transanal endoscopic microsurgery and transanal minimally invasive surgery offer improved visualization and magnification, allowing for finer and more precise dissection of more proximal and larger rectal lesions without compromising patient outcome. Some studies have demonstrated efficacy in utilizing transanal platforms in the surgical management of early rectal malignancies in selected patients. There is an overall higher recurrence rate with transanal surgery with the concern that neither chemoradiation nor salvage surgery may compensate for previous approach and correct the inferior outcome. Application of transanal platforms to accomplish transanal TME in a natural orifice fashion are still in their infancy and currently should be considered experimental. The current data demonstrate that transanal surgery remains an excellent option in the surgical management of benign rectal disease. However, care should be used when selecting patients with malignant disease. The application of transanal platforms continues to evolve. While the new uses of transanal platforms in TME for more advanced rectal malignancy are exciting, it is important to remain cognizant and not sacrifice long term survival for short term decrease in morbidity and improved cosmesis.

机器人辅助直肠癌根治术研究进展

机器人辅助手术(RAS)系统是一种新型操作系统,因其机械臂稳定性高、视野高清放大、手腕部灵活操作等特征在直肠癌根治术中广泛应用,主要包括机器人辅助经腹直肠癌根治术、机器人辅助经肛直肠癌根治术、机器人辅助经自然腔道直肠癌根治术、机器人荧光系统(吲哚菁绿)辅助。机械臂操作的灵活性大大提高了经腹和经肛直肠癌手术的短期疗效,RAS的荧光模式可充分且直观地识别肠管血供情况,有效减少吻合口瘘的发生,因此RAS有望成为直肠癌根治术的新一代经典治疗方案之一。

经肛全直肠系膜切除术治疗直肠癌的效果及对胃肠功能的影响

目的:探究经肛全直肠系膜切除术(ta TME)治疗直肠癌的效果。方法:选择2021年4月—2023年4月在枣庄市立医院治疗的直肠癌患者94例,应用随机数字表法将其分为对照组[予以全直肠系膜切除术(TME)]及观察组(予以taTME),各47例。对比两组术中临床指标、术后临床指标、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]、胃肠功能[胃动素(MOT)、胃泌素(GAS)、碱性成纤维细胞生长因子(BFGF)]、肛门功能[肛管最大收缩压(AMSP)、肛管静息压(ARP)、直肠最大耐受量(RMTV)]、并发症发生率。结果:观察组手术时间长于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);两组淋巴结清扫数量比较,差异无统计学意义(P>0.05)。观察组排气时间、进食时间、排便时间、肠鸣音恢复时间均早于对照组,差异均有统计学意义(P<0.05)。术前,两组炎症因子水平比较,差异均无统计学意义(P>0.05);术后,两组TNF-α、IL-6、CRP均升高,但观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,两组胃肠功能指标比较,差异无统计学意义(P>0.05);术后,两组MOT、GAS、BFGF均降低,观察组均高于对照组,差异均有统计学意义(P<0.05)。术前,两组肛门功能指标比较,差异无统计学意义(P>0.05);术后,两组AMSP、ARP、RMTV均降低,观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:直肠癌患者选择taTME治疗,能够减轻炎症反应,对肛门功能、胃肠功能的影响较小,且可降低并发症发生率。

腹腔镜辅助经肛全系膜切除术后低位前切除综合征的发生及影响因素相关研究

目的探讨分析腹腔镜辅助经肛全系膜切除术(TaTME)后低位前切除综合征的发生及影响因素,为今后改善TaTME治疗直肠癌患者的排便功能提供依据。方法选取2019年1月至2023年1月惠州市中心人民医院胃肠外科收治的62例行腹腔镜TaTME中低位直肠癌患者,术后3个月、6个月依据直肠癌低位前切除综合征(LARS)量表评分分为LARS组和FLARS组,分别分析术后3个月、6个月发生LARS的影响因素(单因素、多因素回归分析)。结果术后3个月LARS发生率为66.13%,显著高于术后6个月(41.94%)(P<0.05)。术后3个月单因素和多因素分析均显示:LARS发生的独立危险因素为肿瘤直径、术前放化疗率及吻合口距肛缘距离;术后6个月单因素和多因素分析均显示:LARS发生的独立危险因素为术前放化疗率、吻合口距肛缘距离。结论TaTME治疗中低位直肠癌患者,术后3个月LARS发生率显著高于术后6个月,患者术后康复训练和疾病恢复密切相关,TaTME术后发生LARS的独立危险因素为同步放化疗、术后吻合口距肛缘距离(<2cm)、肿瘤直径(≥5cm),在手术过程需要引起注意,加以干预,降低术后LARS发生率,改善患者排便功能。

机器人手术系统在经肛腔镜外科体系中的应用进展

近年来,机器人手术系统在国内外经肛腔镜外科体系中日益发展成熟,凭借着高度符合人体工程力学、3D高清视野、Endowrist^(TM)技术允许7个自由度的转腕以及震颤消除功能等优势,被认为是腹腔镜辅助经肛门微创手术的宝贵替代平台。然而,机器人手术系统也存在手术时间长,成本高,缺乏长期循证医学数据等争议。目前研究报道,各种新型机器人辅助经肛门微创手术已经成功用于复杂直肠肿瘤局部切除,经肛门全直肠系膜切除,直肠瘘修复等手术。在未来,机器人手术系统的技术更新将极大拓展经肛腔镜外科体系的施展空间。文章主要就机器人辅助经肛门微创手术的发展、在国内外的应用进展以及存在的争议问题进行综述。

“防治康”三结合策略在腹腔镜经肛门全直肠系膜切除术患者术后康复中的应用研究

目的探讨“防治康”三结合策略在腹腔镜经肛门全直肠系膜切除术(TaTME)患者术后康复中的应用研究。方法选取2020年12月至2022年12月在中山市人民医院肿瘤外科60例TaTME患者作为研究对象,按随机数表法分为结合策略组和传统康复组,每组各30例。传统康复组给予传统的康复指导及院后指导,结合策略组实施“防治康”三结合策略护理措施。观察比较两组患者护理效果,观察指标包括患者肛门功能状态、胃肠功能状态、运动能力情况、术后恢复质量和术后并发症情况。结果经干预后,结合策略组术后恢复质量评分高于传统康复组,术后住院时间少于传统康复组,差异有统计学意义(P<0.05);干预后,结合策略组术后下床活动时间、首次肛门排气时间少于传统康复组,差异有统计学意义(P<0.05);首次排便时间略少于传统康复组,差异无统计学意义(P>0.05);干预后,结合策略组术后并发症发生率低于传统康复组,差异有统计学意义(P<0.05)。结论“防治康”三结合策略能够有效提高TaTME患者术后恢复质量,降低术后住院时间,改善术后首次排气时间,值得临床推广应用。

4K腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌的临床分析

目的 探究4K腹腔镜辅助经肛全直肠系膜切除术(TaTME)治疗低位直肠癌的临床效果。方法 选取2019年7月至2021年1月于本院接受4K腹腔镜辅助TaTME治疗的52例低位直肠癌患者为观察组,另选取2018年1月至2019年6月接受腹腔镜辅助全直肠系膜切除术(LaTME)治疗的50例低位直肠癌患者为对照组。比较2组患者手术指标及术后3个月肛门功能恢复情况;比较2组患者的生存情况。结果 与对照组相比,观察组患者手术时间长、术中出血量多、切缘与肿瘤下缘距离短、手术费用少,差异均具有统计学意义(P<0.05)。术后3个月,观察组患者肛门功能恢复率为94.23%,明显高于对照组的80.00%,差异具有统计学意义(P<0.05)。2组患者随访20~47个月,平均(33.90±9.75)个月,其中观察组死亡6例(肿瘤相关死亡3例,心、肾功能疾病3例),对照组肿瘤相关死亡8例。Kaplan-Meier结果显示,2组患者的平均生存时间差异无统计学意义(P>0.05)。结论 4K腹腔镜辅助TaTME治疗低位直肠癌,可以提高患者的肛门功能恢复质量,减少手术费用,但更细致的手术操作会延长手术时间,增加术中出血量,需要结合患者具体情况制定治疗方案。

低位直肠癌病人肛全直肠系膜切除术后中期排便功能障碍发生风险Nomogram模型构建

目的:分析影响低位直肠癌病人行肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)后中期排便功能障碍发生的危险因素,并建立Nomogram模型。方法:选择2016年1月至2020年1月172例低位直肠癌并接受腹腔镜辅助TaTME手术病人作为建模组,选择2020年2月至2021年2月间接受相同手术病人32例作为验证组;建模组病人根据术后6个月随访时是否发生低位前切除综合征(low anterior resection syndrome,LARS)分为LARS组和非LARS组,比较2组病人病历资料,采用单因素和多因素logistic回归模型对影响LARS发生的独立危险因素进行分析,并采用R软件建立预测低位直肠癌病人TaTME术后LARS发生的列线图模型,并进行验证。结果:病人的LARS评分为(14.78±4.54)分,其中LARS病人84例(48.84%),非LARS病人LARS 88例(51.16%)。单因素、多因素logistic回归分析显示术前放疗、肛门括约肌损伤、吻合口距离肛缘距离、肿瘤直径、坐骨棘间径长度均是影响LARS的独立危险因素(P<0.05~P<0.01)。列线图模型预测建模组、验证组的C-index分别为0.836和0.827。ROC曲线显示,列线图模型预测建模组、验证组发生LARS的AUC分别为0.829、0.808。结论:术前放疗、肛门括约肌损伤、吻合口距离肛缘距离、肿瘤直径、坐骨棘间径长度是影响是否发生LARS的独立危险因素,以上述指标建立的列线图模型具有良好预测效能。

经肛全直肠系膜切除治疗直肠癌十年回顾与展望

直肠癌是消化道最常见的恶性肿瘤之一。以手术为中心的多学科疗法仍是治疗直肠癌的主要策略。在我国,直肠癌以中低位居多,近年来,经肛全直肠系膜切除(taTME)成为中低位直肠癌手术的热点领域。自2010年首次报道至今,taTME手术已历经逾10年的发展,该术式在技术上的不断进步,已逐渐形成了一套较为规范的理论和实践体系。同时,国内外研究的持续推进以及专家共识和指南的迭代推出,为该术式的安全性与有效性提供了科学证据。未来,期待我国的研究中心开展更广泛的结构化培训和临床试验,获得基于我国taTME临床研究结果的高级别循证医学证据,形成更成熟的的taTME临床实践指南,来更安全规范地开展该技术,以期望为更多的直肠癌患者带来获益。

经肛全直肠系膜切除术用于直肠癌吻合口复发的再手术

目的:探讨经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)在直肠癌吻合口复发再手术中的可行性及安全性。方法:回顾性收集2020年4月至2021年12月瑞金医院收治的5例直肠癌术后吻合口复发行腹腔镜辅助TaTME病人的临床资料。分析病人围术期情况、病理检查结果和近期随访。结果:5例均顺利完成腹腔镜辅助TaTME手术。手术时间(206.00±19.49)min,无术中并发症发生,1例术中遭遇错误间隙。术后发生吻合口漏1例,吻合口狭窄1例。所有病人的切除标本均完整,无环周切缘阳性和远切缘阳性。中位随访(15.20±2.39)个月。1例病人出现排便功能障碍,无肿瘤复发、转移及肿瘤相关性死亡。结论:腹腔镜辅助TaTME对直肠癌术后吻合口复发再手术病人,提供了一种新型、安全有效的手术入路和切除方式,近期随访满意。