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首页> 外文期刊>Journal of laparoendoscopic and advanced surgical techniques, Part A >Transanal Endoscopic Microsurgery After Neoadjuvant Chemoradiotherapy for Rectal Cancer
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Transanal Endoscopic Microsurgery After Neoadjuvant Chemoradiotherapy for Rectal Cancer

机译：新辅助放化疗后经肛门内镜显微手术治疗直肠癌

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Background: Radical rectal resection following neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer is accompanied by relatively high morbidity. Local excision of rectal cancer may be more appropriate for some frail patients with severe comorbidities. Transanal endoscopic microsurgery (TEM), consisting of local excision of selected rectal cancers, has been associated with low rates of postoperative complications. Because neoadjuvant CRT for rectal cancer may be associated with increased complications, the suitability of TEM following CRT is still unclear. In this study we aimed to assess the clinical outcomes of patients undergoing TEM following neoadjuvant CRT. Patients and Methods: This study retrospectively analyzed all patients undergoing TEM for malignant rectal tumor in our institution between 2004 and 2010. They were divided into those who received CRT (CRT group) and those without CRT (non-CRT group). Demographics and clinical data were compared. Results: Forty-four of 97 patients who underwent TEM were included: 13 CRT and 31 non-CRT. Age, comorbidities, and the duration of the procedure were similar for both groups. There were no significant group differences in tumor diameter (2.1 cm [range, 0.5-3.5 cm] and 2.9 cm [range, 0.5-4.2 cm], respectively; P=.125) or distance of the lower part of the tumor from the anal verge (6.7 cm [range, 5-10 cm] and 7.7 cm [range, 5-15 cm], respectively; P=.285). Two non-CRT patients had peritoneal entry, and 1 of them underwent protective ileostomy because of insecure rectal defect closure. One non-CRT patient underwent a re-operation for postoperative bleeding. The other perioperative complications were minor and included urinary retention requiring catheter placement (2 patients in each group), pulmonary edema (1 non-CRT patient), and pneumonia (1 non-CRT patient). All complications were managed conservatively. There was no wound disruption, major complication, or mortality in either group. Conclusions: With proper patient selection, TEM can be performed safely following CRT, without major complication or increased postoperative morbidity.
机译：背景：对于局部晚期直肠癌，新辅助化学放疗（CRT）后进行根治性直肠癌切除术的发生率较高。对于一些患有严重合并症的体弱患者，直肠癌的局部切除术可能更合适。经肛门内窥镜显微手术（TEM），包括局部切除直肠癌，与术后并发症发生率低有关。由于直肠癌的新辅助CRT可能与并发症增加有关，因此CRT后TEM的适用性仍不清楚。在这项研究中，我们旨在评估新辅助CRT后接受TEM的患者的临床结局。患者与方法：本研究回顾性分析了2004年至2010年间我院所有因直肠恶性肿瘤而接受TEM治疗的患者。他们分为接受CRT治疗的患者（CRT组）和不接受CRT治疗的患者（非CRT组）。比较了人口统计学和临床​​数据。结果：97例行TEM的患者中包括44例：13例CRT和31例非CRT。两组的年龄，合并症和手术时间相似。肿瘤直径（分别为2.1 cm [范围，0.5-3.5 cm]和2.9 cm [范围，0.5-4.2 cm]，P = .125）或肿瘤下部距肿瘤的距离均无显着组差异。肛门边缘（分别为6.7厘米（5-10厘米）和7.7厘米（5-15厘米）; P = .285）。 2名非CRT病人进入了腹膜，其中1名因直肠缺损闭合不安全而接受了保护性回肠造口术。一名非CRT患者因术后出血而再次手术。其他围手术期并发症较轻，包括需要置入导管的尿retention留（每组2例），肺水肿（1例非CRT患者）和肺炎（1例非CRT患者）。所有并发症均保守治疗。两组均未出现伤口破裂，严重并发症或死亡。结论：通过适当的患者选择，可以在CRT后安全地进行TEM，而没有大的并发症或增加的术后发病率。

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