Transanal Total Mesorectal Excision in Mid-Low Rectal Cancer: Evaluation of the Learning Curve and Comparison of Short-term Results With Standard Laparoscopic Total Mesorectal Excision
| Autor: | Shuangling Luo, Ziwei Zeng, Liang Huang, Zhihang Liu, Liang Kang, Xingwei Zhang, Huashan Liu, Haiqing Jie |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Demographics Operative Time Blood Loss Surgical 03 medical and health sciences Postoperative Complications 0302 clinical medicine Low rectal cancer Blood loss Outcome Assessment Health Care medicine Humans Laparoscopic resection Aged Data Management Neoplasm Staging Retrospective Studies Transanal Endoscopic Surgery Gynecology Proctectomy Rectal Neoplasms business.industry Gastroenterology Margins of Excision General Medicine Length of Stay Middle Aged Total mesorectal excision Single surgeon Case-Control Studies 030220 oncology & carcinogenesis Operative time Female Laparoscopy 030211 gastroenterology & hepatology Neoplasm Recurrence Local business Colorectal surgeons Learning Curve |
| Zdroj: | Diseases of the Colon & Rectum. 64:380-388 |
| ISSN: | 0012-3706 |
| Popis: | Background Ever since transanal total mesorectal excision was introduced by Sylla and Lacy in 2010, it has become more popular among colorectal surgeons. However, some surgeons hesitate to use it, because this novel approach differs greatly from laparoscopic total mesorectal excision and requires a long learning curve. Objective This study analyzed the learning curve of transanal total mesorectal excision procedure and compared the different phases of transanal total mesorectal excision with laparoscopic total mesorectal excision. Design This is retrospective case-control study. Settings We used data from the approved colorectal cancer database of the Sixth Affiliated Hospital of Sun Yat-sen University. Patients The patients involved in this study underwent transanal total mesorectal excision performed by a single surgeon (L.K.) or underwent laparoscopic transanal total mesorectal excision performed by experienced surgeons. Interventions Transanal or laparoscopic resection of mid-low rectal cancer was conducted. Main outcomes measures Perioperative complication and resection margin were measured. Results A total of 342 patients were included in both groups. The learning curve of transanal total mesorectal excision was divided into 3 phases. Data show that demographics and tumor characteristics were not significantly different between the matched groups. Indeed, during phase 1, only operative time was longer than in the laparoscopic group, whereas, during phase 2, results from the transanal group were comparable with the laparoscopic group. Results show that, during phase 3, operative time, intraoperative blood loss, and postoperative hospital stay were all lower than in the laparoscopic group. Local recurrence occurred in 3 patients during phase 1 and in 1 patient during phase 2. Limitations This study was a small retrospective study and focused on just 1 surgeon performing transanal total mesorectal excision. Conclusions Short-term and histopathologic outcomes are similar compared between a transanal group and matched laparoscopic group. Transanal total mesorectal excision also provided good oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/B450. Escisin mesorrectal total transanal en el cncer de recto mediobajo evaluacin de la curva de aprendizaje y comparacin de resultados a corto plazo con tme laparoscpica estndar ANTECEDENTES:Desde que Sylla y Lacy introdujeron la escision mesorrectal total transanal en 2010, se ha vuelto mas popular entre los cirujanos colorrectales. Sin embargo, algunos cirujanos dudan en utilizarlo, porque este nuevo metodo difiere mucho de la escision mesorrectal total laparoscopica y requiere una larga curva de aprendizaje.OBJETIVO:Este estudio analizo la curva de aprendizaje del procedimiento de escision mesorrectal total transanal y comparo las diferentes fases de la escision mesorrectal total transanal con la escision mesorrectal total laparoscopica.DISENO:Este es un estudio retrospectivo de casos y controles.ENTORNO CLINICO:Utilizamos base de datos de cancer colorrectal aprobada del Sexto Hospital Afiliado de la Universidad Sun Yat-sen (Guangzhou, China).PACIENTES:Los pacientes involucrados en este estudio fueron sometidos a escision mesorrectal total transanal realizada por un solo cirujano (LK) o se sometieron a escision mesorrectal total transanal laparoscopica realizada por cirujanos experimentados.INTERVENCIONES:Reseccion transanal o laparoscopica de cancer de recto medio-bajo.PRINCIPALES MEDIDAS DE VOLARCION:complicacion perioperatoria y margen de reseccion.RESULTADOS:Se incluyo un total de 342 pacientes en ambos grupos. La curva de aprendizaje de la escision mesorrectal total transanal se dividio en tres fases. Los datos muestran que las caracteristicas demograficas y tumorales no fueron significativamente diferentes entre los grupos emparejados. De hecho, durante la fase 1, solo el tiempo operatorio fue mas largo que en el grupo laparoscopico. Mientras que durante la fase 2, los resultados del grupo transanal fueron comparables a los del grupo laparoscopico. Los resultados muestran que durante la fase 3, el tiempo operatorio, la perdida de sangre intraoperatoria y la estancia hospitalaria postoperatoria fueron menores que en el grupo laparoscopico. La recurrencia local ocurrio en 3 pacientes durante la fase 1 y en 1 paciente durante la fase 2.LIMITACIONES:Este estudio fue un estudio retrospectivo pequeno y se centro en un solo cirujano que realizaba la escision mesorrectal total transanal.CONCLUSION:Los resultados a corto plazo e histopatologicos son similares en comparacion entre el grupo transanal y el grupo laparoscopico emparejado. La escision mesorrectal total transanal tambien proporciono buenos resultados oncologicos. Consulte Video Resumen en http://links.lww.com/DCR/B450. |
| Databáze: | OpenAIRE |
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