PDF(Pubmed)
Abstract：
BACKGROUND: Transanal total mesorectal excision (TaTME), a novel approach for treating low rectal cancer, holds promise. However, concerns exist in certain countries about their oncologic safety due to less-than-optimal outcomes on global studies. This research seeks to evaluate the long-term oncologic outcomes focusing on local recurrence rate and overall survival after TaTME surgery in Germany.
METHODS: This study analyzed data from patients who underwent elective TaTME surgery between 2014 and 2021 in four certified colorectal cancer centers in Germany. Primary endpoints were 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary outcomes encompassed overall survival (OS), operative time, completeness of local tumor resection, lymph node resection, and postoperative complications.
RESULTS: A total of 378 patients were analyzed (mean age 61.6 years; 272 males, 72%). After a median follow-up period of 2.5 years, 326 patients with UICC-stages I-III and tumor operability included in survival analyses. Local recurrence was observed in 8 individuals, leading to a 3-year cumulative local recurrence rate of 2.2% and a 3-year LRFS rate of 88.1%. The 3-year OS rate stood at 88.9%. Within 30 days after surgery, anastomotic leakage occurred in 19 cases (5%), whereas a presacral abscess was present in 12 patients (3.2%).
CONCLUSIONS: TaTME proves effective in addressing the anatomical and technical challenges of low rectal surgery and is associated with pleasing short- and long-term results. However, its safe integration into surgical routine necessitates sufficient knowledge and a previously completed training program.
METHODS: This study analyzed data from patients who underwent elective TaTME surgery between 2014 and 2021 in four certified colorectal cancer centers in Germany. Primary endpoints were 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary outcomes encompassed overall survival (OS), operative time, completeness of local tumor resection, lymph node resection, and postoperative complications.
RESULTS: A total of 378 patients were analyzed (mean age 61.6 years; 272 males, 72%). After a median follow-up period of 2.5 years, 326 patients with UICC-stages I-III and tumor operability included in survival analyses. Local recurrence was observed in 8 individuals, leading to a 3-year cumulative local recurrence rate of 2.2% and a 3-year LRFS rate of 88.1%. The 3-year OS rate stood at 88.9%. Within 30 days after surgery, anastomotic leakage occurred in 19 cases (5%), whereas a presacral abscess was present in 12 patients (3.2%).
CONCLUSIONS: TaTME proves effective in addressing the anatomical and technical challenges of low rectal surgery and is associated with pleasing short- and long-term results. However, its safe integration into surgical routine necessitates sufficient knowledge and a previously completed training program.
摘要：
背景：经肛门全直肠系膜切除术（TaTME），一种治疗低位直肠癌的新方法，持有承诺。然而,由于全球研究结果不理想,某些国家对肿瘤安全性存在担忧.这项研究旨在评估德国TaTME手术后局部复发率和总体生存率的长期肿瘤学结果。
方法：本研究分析了2014年至2021年在德国四个经过认证的结直肠癌中心接受选择性TaTME手术的患者的数据。主要终点是3年局部复发率和无局部复发生存率（LRFS）。次要结局包括总生存期（OS），手术时间,局部肿瘤切除的完整性，淋巴结切除,术后并发症。
结果：共分析了378例患者（平均年龄61.6岁；272例男性，72%)。经过2.5年的中位随访期，326例UICCI-III期和肿瘤可操作性患者纳入生存分析。8例患者局部复发,导致3年累积局部复发率为2.2%，3年LRFS率为88.1%。3年OS率为88.9%。手术后30天内,吻合口漏19例(5%),而12例患者(3.2%)存在骶前脓肿。
结论：TaTME在解决低位直肠手术的解剖学和技术挑战方面被证明是有效的，并且与令人满意的短期和长期结果相关。然而,将其安全地整合到外科手术中需要足够的知识和先前完成的培训计划。
方法：本研究分析了2014年至2021年在德国四个经过认证的结直肠癌中心接受选择性TaTME手术的患者的数据。主要终点是3年局部复发率和无局部复发生存率（LRFS）。次要结局包括总生存期（OS），手术时间,局部肿瘤切除的完整性，淋巴结切除,术后并发症。
结果：共分析了378例患者（平均年龄61.6岁；272例男性，72%)。经过2.5年的中位随访期，326例UICCI-III期和肿瘤可操作性患者纳入生存分析。8例患者局部复发,导致3年累积局部复发率为2.2%，3年LRFS率为88.1%。3年OS率为88.9%。手术后30天内,吻合口漏19例(5%),而12例患者(3.2%)存在骶前脓肿。
结论：TaTME在解决低位直肠手术的解剖学和技术挑战方面被证明是有效的，并且与令人满意的短期和长期结果相关。然而,将其安全地整合到外科手术中需要足够的知识和先前完成的培训计划。
