|Table of Contents|

Clinical efficacy analysis of laparoscopic-assisted transanal total mesorectal excision in the treatment of rectal cancer

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 04
Page:
686-689
Research Field:
Publishing date:

Info

Title:
Clinical efficacy analysis of laparoscopic-assisted transanal total mesorectal excision in the treatment of rectal cancer
Author(s):
LU Chen; LIANG Daoming; XIANG Qianming; XIA Chuqi; LUO Haibo; YANG Yanlong
Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650101，China.
Keywords:
rectal neoplasms; total mesorectal excision; laparoscopes; comparative effectiveness research
PACS:
R735.3
DOI:
10.3969/j.issn.1672-4992.2023.04.017
Abstract:
Objective:To evaluate the feasibility,safety,radical and short-term clinical efficacy of laparoscopic-assisted TaTME in the treatment of rectal cancer.Methods:A retrospective analysis of the clinical data of 58 patients with middle and low rectal cancer (the distance between the lower edge of the tumor and the anal edge≤10 cm) admitted to our hospital from December 2018 to December 2019.Among them,28 cases underwent laparoscopic-assisted transanal total mesorectal excision(TaTME group),and 30 cases underwent laparoscopic total mesorectal excision (LaTME group).To compare the relevant clinical indicators of the two groups.Results:The two groups of patients had no statistically significant differences in general data such as age,gender,distance from the lower edge of the tumor to the anal edge,and depth of tumor invasion,and they were comparable (P>0.05).The operation time of the TaTME group was (187.82±38.99)min,and the operation time of LaTME was (113.00±21.84)min.The difference between the two groups was significant (P＜0.001).Introoperative blood loss［(75.00±18.40)mL vs (73.16±17.88)mL］,the time of postoperative analgesia ［(1.93±0.71)d vs (1.83±0.64)d］,intestinal function recovery time ［(1.76±0.58)d vs (1.75±0.58)d］ and hospitalization time ［(8.43±3.51)d vs (8.07±3.29)d］,there was no difference statistical significance (P>0.05).Postoperative complications were not significantly different between the TaTME group and the LaTME group (P>0.05).The two groups had no difference in the length of specimen resection and the distance of the distal resection margin of the bowel.The pathological examination of the distal resection margin of the two groups was negative.The follow-up time of the two groups has been up to now,and the selected group is below T3,and the patients are reexamined and survived without tumor.Conclusion:TaTME has advantages in dissociating the low rectum and mesangium,improves the surgical resection and specimen quality of low rectal cancer patients with "difficult pelvis".At the same time,it is safe and feasible,and it is equivalent to traditional TME surgery in terms of surgical complications,surgical mortality and other short-term effects.

References:

［1］HEALD RJ,HUSBAND EM,RYALL RD.The mesorectum in rectal cancer surgery-the clue to pelvic recurrence［J］.British Journal of Surgery,1982,69(10):613-616.
［2］姚宏伟,张忠涛,郑民华.直肠癌经肛全直肠系膜切除中国专家共识及临床实践指南（2019版）［J］.中国实用外科杂志,2019,39(11):1121-1128. YAO HW,ZHANG ZT,ZHENG MH.Chinese expert consensus and clinical practice guidelines for transanal total mesorectal resection for rectal cancer (2019 edition) ［J］.Chinese Journal of Practical Surgery,2019,39(11):1121-1128.
［3］SYLLA P,RATTNER DW,DELGADO S,et al.NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance［J］.Surgical Endoscopy,2010,24(5):1205-1210.
［4］ROODBEEN SX,SPINELLI A,BEMELMAN WA,et al.Local recurrence after transanal total mesorectal excision for rectal cancer:a multicenter cohort study［J］.Annals of Surgery,2021,274(2):359-366.
［5］KANG L,CHEN YG,H ZHANG,et al.Transanal total mesorectal excision for rectal cancer:a multicentric cohort study［J］.Gastroenterology Report,2020,8(1):36-41.
［6］REN J,LUO H,LIU S,et al.Short-and mid-term outcomes of transanal versus laparoscopic total mesorectal excision for low rectal cancer:a meta-analysis［J］.Annals of Surgical Treatment and Research,2021,100(2):86.
［7］ZIATI J,SOUADKA A,BENKABBOU A,et al.Transanal total mesorectal excision for patients with rectal cancer:a Systematic review and meta-analysis［J］.Gulf Journal of Oncology,2021,1(35):66-76.
［8］YAO H,AN Y,ZHANG H,et al.Transanal total mesorectal excision:short-term outcomes of 1283 cases from a nationwide registry in China［J］.Diseases of the Colon & Rectum,2021,64(2):190-199.
［9］张旋,高屹,代行龙,等.腹腔镜辅助经肛门全直肠系膜切除术与腹腔镜全直肠系膜切除术治疗中低位直肠癌近、远期疗效比较的Meta分析［J］.中华胃肠外科杂志,2018,21(08):924-935. ZHANG X,GAO Y,DAI XL,et al.Meta-analysis of the short-term and long-term curative effect of laparoscopic-assisted transanal mesorectal resection and laparoscopic mesorectal resection in the treatment of middle and low rectal cancer［J］.China Gastrointestinal Journal of Surgery,2018,21(08):924-935.
［10］HAJIBANDEH S,HAJIBANDEH S,ELTAIR M,et al.Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer［J］.International Journal of Colorectal Disease,2020,35(4):575-593.
［11］丛进春,张宏.经腹及经肛不同视角下的神经血管束损伤机制及解剖学认识［J］.中华胃肠外科杂志,2019,22(10):943-948. CONG JC,ZHANG H.Neurovascular bundle injury mechanism and anatomy under different perspectives of transabdominal and transanal［J］.Chinese Journal of Gastrointestinal Surgery,2019,22(10):943-948.
［12］MCLEMORE ELISABETH C,LAVI PEYMAN,ATTALURI VIKRAM.Learning transanal total mesorectal excision［J］.Clinics in Colon and Rectal Surgery,2020,33(3):168-172.
［13］A CAYCEDO-MARULANDA,CP VERSCHOOR.Experience beyond the learning curve of transanal total mesorectal excision (taTME) and its effect on the incidence of anastomotic leak［J］.Techniques in Coloproctology,2020,24(4):309-316.
［14］CAYCEDO AJ,LEE L,CHADI SA,et al.Association of transanal total mesorectal excision with local recurrence of rectal cancer［J］.JAMA Network Open,2021,4(2):e2036330.
［15］PERSIANI R,AGNES A,BELIA F,et al.The learning curve of TaTME for mid-low rectal cancer:a comprehensive analysis from a five-year institutional experience［J］.Surgical Endoscopy,2021,35(11):6190-6200.
［16］ZENG ZW,LIU ZH,HUANG L,et al.Transanal total mesorectal excision in mid-low rectal cancer:evaluation of the learning curve and comparison of short-term results with standard laparoscopic total mesorectal excision.［J］.Diseases of the Colon and Rectum,2021,64(4):380-388.
［17］李梦,任明扬,徐庆,等.腹腔镜直肠癌经肛全直肠系膜切除术学习曲线的多中心研究［J］.中华消化外科杂志,2021,20(03):306-314. LI M,REN MY,XU Q,et al.A multicenter study on the learning curve of laparoscopic transanal total mesorectal resection for rectal cancer［J］.Chinese Journal of Digestive Surgery,2021,20(03):306-314.
［18］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.

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