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Local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom

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World Journal of Gastrointestinal Surgery 2024年第10期16卷 3114-3122页

作者： Ahmed Farid Matthew Tutton prem thambi TS Gill Jim Khan Department of General Surgery Oncology Center Mansoura UniversityCairo 11432Egypt Department of Colorectal Surgery East Suffolk and North Essex NHS TrustColchester CO11AAEssexUnited Kingdom Department of Colorectal Surgery Portsmouth Hospitals University NHS TrustPortsmouth PO63LYHampshireUnited Kingdom Department of Surgery University Hospital of North TeesStockton on Tees TS18-TS21DarlingtonUnited Kingdom Department of General Surgery Portsmouth Hospitals NHS TrustQueen Alexandra HospitalPortsmouth PO63LYHampshireUnited Kingdom

BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail *** To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United *** TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological *** is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail *** Two hundred and twenty-two patients underwent TEMS *** included 144 males(64.9%)and 78 females(35.1%),Median age was 71 *** median distance of the tumours from the anal verge 4.5 *** tumour size was 2.6 *** most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 *** operating time was 90 *** blood loss was *** were two 90-day *** excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding ***-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.

关键词： Local excision Transanal endoscopic microsurgery Early rectal cancer Rectum preservation Rectum saving

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