Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention

被引：153
作者：
De Graaf, E. J. R. [1 ]
Doornebosch, P. G. [1 ]
Tollenaar, R. A. E. M. [2 ]
Kranenbarg, E. Meershoek-Klein [2 ]
de Boer, A. C. [3 ]
Bekkering, F. C. [4 ]
van de Velde, C. J. H. [2 ]
机构：
[1] IJsselland Hosp, Dept Gen Surg, NL-2900 AR Capelle aan den IJssel, Netherlands
[2] Leiden Univ, Med Ctr, Dept Gen Surg, Leiden, Netherlands
[3] IJsselland Hosp, Dept Internal Med, NL-2900 AR Capelle aan den IJssel, Netherlands
[4] IJsselland Hosp, Dept Gastroenterol, NL-2900 AR Capelle aan den IJssel, Netherlands
来源：
EJSO | 2009年 / 35卷 / 12期
关键词：
T1 rectal cancer; Transanal endoscopic microsurgery; Total mesorectal excision; TEM; TME; Survival; MULTICENTER RANDOMIZED-TRIAL; TERM PREOPERATIVE RADIOTHERAPY; QUALITY-OF-LIFE; LOCAL EXCISION; RADICAL RESECTION; IRRADIATED PATIENTS; COLORECTAL-CANCER; SURGICAL CURE; FOLLOW-UP; CARCINOMA;
D O I：
10.1016/j.ejso.2009.05.001
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
Purpose: After total mesorectal excision (TME) for rectal cancer, pathology is standardized with margin status as a predictor for recurrence. This has yet to be implemented after transanal endoscopic microsurgery (TEM) and was investigated prospectively for T1 rectal adenocarcinomas. Patients and methods: Eighty patients after TEM were compared to 75 patients after TME. The study protocol included standardized pathology. TEM patients were eligible when excision margins were negative. Results: TEM was safer than TME as reflected by operating time, blood loss, hospital stay, morbidity, re-operation rate and stoma formation (all P < 0.001). Mortality after TEM was 0% and after TME 4%. At 5 years after TEM and TME, both overall survival (TEM 75% versus TME 77%, P = 0.9) and cancer-specific survival (TEM 90% versus TME 87%, P = 0.5) were comparable. Local recurrence rate after TEM was 24% and after TME 0% (HR 79.266, 95% CI, 1.208 to 5202, P < 0.0001). Conclusion: For T1 rectal adenocarcinomas TEM is much saver than TME and survival is comparable. After TEM local recurrence rate is substantial, despite negative excision margins. (C) 2009 Elsevier Ltd. All rights reserved.
引用
收藏
页码：1280 / 1285
页数：6
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