Volume 22 Issue 6
Jun.  2024
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ZHENG Jiujian, WANG Jianping. Investigation of the clinical efficacy of transabdominal single-port endoscopic combined with transanal endoscopic techniques in managing low rectal cancer[J]. Chinese Journal of General Practice, 2024, 22(6): 979-982. doi: 10.16766/j.cnki.issn.1674-4152.003548
Citation: ZHENG Jiujian, WANG Jianping. Investigation of the clinical efficacy of transabdominal single-port endoscopic combined with transanal endoscopic techniques in managing low rectal cancer[J]. Chinese Journal of General Practice, 2024, 22(6): 979-982. doi: 10.16766/j.cnki.issn.1674-4152.003548

Investigation of the clinical efficacy of transabdominal single-port endoscopic combined with transanal endoscopic techniques in managing low rectal cancer

doi: 10.16766/j.cnki.issn.1674-4152.003548
Funds:

 2021ZH074

  • Received Date: 2023-12-11
    Available Online: 2024-07-22
  •   Objective  To explore the short-term and mid-term clinical effects of single-port laparoscopy combined with transanal total mesenteric excision for treating low rectal cancer.  Methods  From January 2018 to June 2022, patients diagnosed with low rectal cancer and treated with anterior rectal resection and coloanal anastomosis at Lishui Central Hospital were included in this study. The early and mid-term clinical efficacies were analyzed and compared based on specimen extraction methods.  Results  Among the 62 patients, the average operation time was (182.6±30.5) minutes, with 22 requiring internal sphincter resection. All patients underwent either colostomy end-to-end stapler or manual anastomosis. The first bowel movement at the ileostomy site occurred on average (1.5±0.3) days post-surgery. R0 resection was achieved in 61 patients, with only 1 patient of R1 resection. The average distal resection margin was (6.2±0.3) mm, and 3 patients had positive circumferential resection margins. Pathological analysis showed that 45 complete and 17 nearly complete cases. The average number of lymph nodes obtained was 13.5, with 25 patients yielding fewer than 12 lymph nodes on their specimens. Specimens were extracted from the ileostomy site in 35 cases and through the anal canal in 27 cases. There were significant differences in BMI-related variables (χ2=39.388, P < 0.001) and tumor size (t=4.415, P=0.020) between the two methods. The average postoperative follow-up time was (40.6±5.5) months. The mid-term outcome evaluation indicated an overall survival rate of 98.4%, disease-free survival rate of 80.6%, and local control rate of 95.2% among the study subjects.  Conclusion  Laparoscopy combined with transanal endoscopic techniques can achieve ideal short-and medium-term clinical effects in the treatment of low rectal cancer, facilitate sufficient tumor resection, and minimize complications through smaller wounds.

     

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  • [1]
    WILKINSON N. Management of rectal cancer[J]. Surg Clin North Am, 2020, 100(3): 615-628. doi: 10.1016/j.suc.2020.02.014
    [2]
    白雪杉, 林国乐, 薛晓强, 等. 以经肛门内镜微创手术为平台经肛全直肠系膜切除术治疗中低位直肠癌的临床疗效[J]. 中华消化外科杂志, 2021, 20(3): 339-345. doi: 10.3760/cma.j.cn115610-20210209-00075

    BAI X S, LIN G L, XUE X Q, et al. Clinical efficacy of transanal total mesorectal excision in the treatment of middle and low rectal cancer using transanal endoscopic minimally invasive surgery as a platform[J]. Chinese Journal of Digestive Surgery, 2021, 20(3): 339-345. doi: 10.3760/cma.j.cn115610-20210209-00075
    [3]
    SCHIETROMA M, ROMANO L, APOSTOL A I, et al. Mid-and low-rectal cancer: laparoscopic vs open treatment-short-and long-term results. Meta-analysis of randomized controlled trials[J]. Int J Colorectal Dis, 2022, 37(1): 71-99. doi: 10.1007/s00384-021-04048-9
    [4]
    孙戈, 臧怡雯, 丁海波, 等. 适形切除保肛术与经括约肌间切除术治疗低位直肠癌的临床疗效[J]. 中华消化外科杂志, 2021, 20(3): 292-300. doi: 10.3760/cma.j.cn115610-20201231-00819

    SUN G, ZANG Y W, DING H B, et al. Clinical efficacy of conformal resection, anus-preserving surgery and transsphincteric resection in the treatment of low rectal cancer[J]. Chinese Journal of Digestive Surgery, 2021, 20(3): 292-300. doi: 10.3760/cma.j.cn115610-20201231-00819
    [5]
    PYO D H, HUH J W, LEE W Y, et al. The role of transanal tube after low anterior resection in patients with rectal cancer treated with neoadjuvant chemoradiotherapy: a propensity score-matched study[J]. Surgery, 2023, 173(2): 335-341. doi: 10.1016/j.surg.2022.10.033
    [6]
    姚宏伟, 安勇博, 李俊, 等. 如何做好经肛全直肠系膜切除规范化手术、数据录入及数据库管理[J]. 中华胃肠外科杂志, 2019, 22(3): 296-299.

    YAO H W, AN Y B, LI J, et al. How to perform standardized surgery, data entry and database management of transanal total mesorectal excision[J]. Chinese Journal of Gastrointestinal Surgery, 2019, 22(3): 296-299.
    [7]
    LI Z, WANG Q, FENG Q, et al. Laparoscopic intersphincteric resection vs. transanal total mesorectal excision in overweight patients with low rectal cancer[J]. Front Surg, 2022, 9: 984680. DOI: 10.3389/fsurg.2022.984680.
    [8]
    揭海清, 李泽, 罗双灵, 等. 经肛手工加固低位吻合口在直肠癌经肛全直肠系膜切除术后预防吻合口漏中的作用[J]. 中华胃肠外科杂志, 2021, 24(6): 530-535. doi: 10.3760/cma.j.cn.441530-20210408-00151

    JIE H Q, LI Z, LUO S L, et al. The role of transanal manual reinforcement of low anastomosis in preventing anastomotic leakage after transanal total mesorectal resection for rectal cancer[J]. Chinese Journal of Gastrointestinal Surgery, 2021, 24(6): 530-535. doi: 10.3760/cma.j.cn.441530-20210408-00151
    [9]
    ENOMOTO H, ITO M, SASAKI T, et al. Anastomosis-related complications after stapled anastomosis with reinforced sutures in transanal total mesorectal excision for low rectal cancer: a retrospective single-center study[J]. Dis Colon Rectum, 2022, 65(2): 246-253. doi: 10.1097/DCR.0000000000002016
    [10]
    ZHAO S, ZHANG L, GAO F, et al. Transanal drainage tube use for preventing anastomotic leakage after laparoscopic low anterior resection in patients with rectal cancer: a randomized clinical trial[J]. JAMA Surg, 2021, 156(12): 1151-1158. doi: 10.1001/jamasurg.2021.4568
    [11]
    王永森, 谢贻祥, 王传思, 等. 腹腔镜下保留左结肠动脉直肠癌根治术的临床研究[J]. 中华全科医学, 2022, 20(3): 366-370. doi: 10.16766/j.cnki.issn.1674-4152.002354

    WANG Y S, XIE Y X, WANG C S, et al. Clinical study on laparoscopic left colic artery-preserving radical resection of rectal cancer[J]. Chinese Journal of General Practice, 2022, 20(3): 366-370. doi: 10.16766/j.cnki.issn.1674-4152.002354
    [12]
    BHATTACHARYA P, PATEL I, FAZILI N, et al. Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer: importance of appropriate patient selection[J]. World J Gastrointest Surg, 2022, 14(12): 1397-1410. doi: 10.4240/wjgs.v14.i12.1397
    [13]
    王政宇, 刘牧林. 腹腔镜结直肠癌根治术治疗不同分期结直肠癌的短期疗效及安全性分析[J]. 中华全科医学, 2018, 16(10): 1659-1661. doi: 10.16766/j.cnki.issn.1674-4152.000452

    WANG Z Y, LIU M L. Analysis of the short-term efficacy and safety of laparoscopic radical colorectal resection in the treatment of different stages of colorectal cancer[J]. Chinese Journal of General Practice, 2018, 16(10): 1659-1661. doi: 10.16766/j.cnki.issn.1674-4152.000452
    [14]
    PARK J W, KANG S B, HAO J, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2021, 6(7): 569-577. doi: 10.1016/S2468-1253(21)00094-7
    [15]
    SHIMIZU H, YAMAGUCHI S, ISHII T, et al. Who needs diverting ileostomy following laparoscopic low anterior resection in rectal cancer patients? Analysis of 417 patients in a single institute[J]. Surg Endosc, 2020, 34(2): 839-846. doi: 10.1007/s00464-019-06837-4
    [16]
    YANG B, ZHANG S, YANG X, et al. Analysis of bowel function, urogenital function, and long-term follow-up outcomes associated with robotic and laparoscopic sphincter-preserving surgical approaches to total mesorectal excision in low rectal cancer: a retrospective cohort study[J]. World J Surg Oncol, 2022, 20(1): 167. doi: 10.1186/s12957-022-02631-0
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