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首页> 外文期刊>Surgical Endoscopy >Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes
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Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes

机译：TransAnal总培素切除（TATME）对MRI定义的低直肠癌腹腔镜TME：促进肿瘤术匹配分析

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BackgroundWhile a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI.MethodsFrom June 2013, all consecutive TaTME cases were included and compared to lapTME in a single institution. Propensity score-matching was performed for nine relevant factors. Primary outcome was resection margin involvement (R1), secondary outcomes included intra- and post-operative outcomes.ResultsAfter matching, forty-one patients were included in each group; no significant differences were observed in patient and tumor characteristics. The resection margin was involved in 5 cases (12.2%) in the laparoscopic group, versus 2 (4.9%) TaTME cases (P=0.432). The TME specimen quality was complete in 84.0% of the laparoscopic cases and in 92.7% of the TaTME cases (P=0.266). Median distance to the circumferential resection margin (CRM) was 5mm in lapTME and 10mm in TaTME (P=0.065). Significantly more conversions took place in the laparoscopic group, 9 (22.0%) compared to none in the TaTME group (P<0.001). Other clinical outcomes did not show any significant differences between the two groups.ConclusionThis is the first study to compare results of TaTME with lapTME in a highly selected patient group with MRI-defined low rectal tumors. A significant decrease in R1 rate could not be demonstrated, although conversion rate was significantly lower in this TaTME cohort.
机译：背景，发生了直肠癌手术中的血液侵入技术的转变，但腹腔镜的非自效性肯定没有明确证明。 TransAnal总培养器切除（TATME）已经开创于潜在地克服在骨盆中深下腹部腹部接近操作时经历的困难。本研究旨在比较TATME与腹腔镜TME（Laptme）的短期肿瘤学结果，基于对MRI的低直肠癌的严格解剖定义。从2013年6月，所有连续的TATME病例都包含在单个机构中的LaptMe 。对九个相关因素进行倾向分数匹配。主要结果是切除利润率参与（R1），次要结果包括术中和后期后果。结果匹配，每组均包括匹配，4名患者;在患者和肿瘤特征中没有观察到显着差异。切除保证金参与腹腔镜组5例（12.2％），而2（4.9％）TATME病例（P = 0.432）。 TME标本质量在腹腔镜病例的84.0％中完成，占TATME病例的92.7％（P = 0.266）。距离周向切除缘（CRM）的距离为5毫米，TATME在10毫米（P = 0.065）。在腹腔镜组中发生显着更大的转化率，9（22.0％）与TATME组无无效（P <0.001）。其他临床结果没有显示两组之间的任何显着差异。结论是第一次研究在具有MRI定义的低直肠肿瘤的高度选定的患者组中将TATME与Laptme的结果进行比较。 R1速率的显着降低，尽管在该TATME队列中转化率显着降低。

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