PDF(Pubmed)
Abstract：
UNASSIGNED: To investigate the oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer and risk factors for local recurrence (LR).
UNASSIGNED: A high LR rate with a multifocal pattern early after TaTME has been reported in Norway and the Netherlands, causing controversy over the oncological safety of this technique.
UNASSIGNED: Twenty-six member institutions of the Japan Society of Laparoscopic Colorectal Surgery participated in this retrospective cohort study. A total of 706 patients with primary rectal cancer who underwent TaTME between January 2012 and December 2019 were included for analysis. The primary endpoint was the cumulative 3-year LR rate.
UNASSIGNED: A total of 253 patients had clinical stage III disease (35.8%) and 91 (12.9%) had stage IV. Intersphincteric resection was performed in 318 patients (45.0%) and abdominoperineal resection in 193 (27.3%). There was 1 urethral injury (0.1%). A positive resection margin (R1) was seen in 42 patients (5.9%). Median follow-up was 3.42 years, and the 2- and 3-year cumulative LR rates were 4.95% (95% confidence interval: 3.50-6.75) and 6.82% (95% confidence interval: 5.08-8.89), respectively. A multifocal pattern was observed in 14 (25%) of 56 patients with LR. Tumor height from the anal verge, pathological T4 disease, pathological stage III/IV, positive perineural invasion, and R1 resection were significant risk factors for LR in multivariable analysis.
UNASSIGNED: In this selected cohort in which intersphincteric resection or abdominoperineal resection was performed in more than half of cases, oncological outcomes were acceptable during a median follow-up of more than 3 years.
UNASSIGNED: A high LR rate with a multifocal pattern early after TaTME has been reported in Norway and the Netherlands, causing controversy over the oncological safety of this technique.
UNASSIGNED: Twenty-six member institutions of the Japan Society of Laparoscopic Colorectal Surgery participated in this retrospective cohort study. A total of 706 patients with primary rectal cancer who underwent TaTME between January 2012 and December 2019 were included for analysis. The primary endpoint was the cumulative 3-year LR rate.
UNASSIGNED: A total of 253 patients had clinical stage III disease (35.8%) and 91 (12.9%) had stage IV. Intersphincteric resection was performed in 318 patients (45.0%) and abdominoperineal resection in 193 (27.3%). There was 1 urethral injury (0.1%). A positive resection margin (R1) was seen in 42 patients (5.9%). Median follow-up was 3.42 years, and the 2- and 3-year cumulative LR rates were 4.95% (95% confidence interval: 3.50-6.75) and 6.82% (95% confidence interval: 5.08-8.89), respectively. A multifocal pattern was observed in 14 (25%) of 56 patients with LR. Tumor height from the anal verge, pathological T4 disease, pathological stage III/IV, positive perineural invasion, and R1 resection were significant risk factors for LR in multivariable analysis.
UNASSIGNED: In this selected cohort in which intersphincteric resection or abdominoperineal resection was performed in more than half of cases, oncological outcomes were acceptable during a median follow-up of more than 3 years.
摘要：
■探讨直肠癌经肛门全直肠系膜切除术（TaTME）后的肿瘤学结果和局部复发（LR）的危险因素。
■据报道，挪威和荷兰在TaTME之后早期出现了高LR率和多焦点模式，引起了对这种技术的肿瘤安全性的争议。
■日本腹腔镜结直肠外科学会的26个成员机构参加了这项回顾性队列研究。纳入2012年1月至2019年12月接受TaTME治疗的原发性直肠癌患者共706例进行分析。主要终点是累积3年LR率。
■共有253例患者有临床III期疾病（35.8%），91例（12.9%）有IV期。318例（45.0％）进行了括约肌间切除术，193例（27.3％）进行了腹部手术切除。尿道损伤1例(0.1%)。42例患者（5.9％）出现阳性切缘（R1）。中位随访时间为3.42年，2年和3年累计LR率分别为4.95%(95%置信区间:3.50-6.75)和6.82%(95%置信区间:5.08-8.89),分别。在56例LR患者中，有14例（25％）观察到多焦模式。从肛门边缘的肿瘤高度，病理T4疾病，病理III/IV期，神经周浸润阳性,在多变量分析中，R1切除是LR的重要危险因素。
■在这个选定的队列中，一半以上的病例进行了括约肌间切除术或腹部会阴切除术，在超过3年的中位随访期间,肿瘤结局是可接受的.
■据报道，挪威和荷兰在TaTME之后早期出现了高LR率和多焦点模式，引起了对这种技术的肿瘤安全性的争议。
■日本腹腔镜结直肠外科学会的26个成员机构参加了这项回顾性队列研究。纳入2012年1月至2019年12月接受TaTME治疗的原发性直肠癌患者共706例进行分析。主要终点是累积3年LR率。
■共有253例患者有临床III期疾病（35.8%），91例（12.9%）有IV期。318例（45.0％）进行了括约肌间切除术，193例（27.3％）进行了腹部手术切除。尿道损伤1例(0.1%)。42例患者（5.9％）出现阳性切缘（R1）。中位随访时间为3.42年，2年和3年累计LR率分别为4.95%(95%置信区间:3.50-6.75)和6.82%(95%置信区间:5.08-8.89),分别。在56例LR患者中，有14例（25％）观察到多焦模式。从肛门边缘的肿瘤高度，病理T4疾病，病理III/IV期，神经周浸润阳性,在多变量分析中，R1切除是LR的重要危险因素。
■在这个选定的队列中，一半以上的病例进行了括约肌间切除术或腹部会阴切除术，在超过3年的中位随访期间,肿瘤结局是可接受的.
