摘要
经肛全直肠系膜切除术(taTME)作为一种诞生十余年的新兴直肠癌手术入路,其发展过程中的坎坷经历提示着我们提升其手术质量的重要性。针对目前taTME的质量评估,其主要优势在于可以增加远切缘距离、降低环周切缘阳性率,并提升全直肠系膜标本的切除质量。由于目前高质量临床研究开展仍然较少,且已发表的研究仍不能除外混杂偏倚以及发表偏倚所带来的局限性,故对于当前结论仍需审慎看待。现阶段,仅推荐taTME在具有高度选择性的患者和中心进行开展。因此,本文对于taTME手术质量的评估及在此基础上的患者与医疗中心的筛选进行探讨。根据目前研究结果和我中心实践经验,我们通常选择具有困难骨盆特征、低位直肠癌和(或)行新辅助放化疗需直视下确定远切缘的患者开展taTME手术。
As a rapid developing rectal cancer procedure that has been in existence for more than a decade,transanal total mesorectal excision(taTME)has had a rough experience along the way,suggesting the importance of improving its surgical quality.In the current view of quality control of taTME,its main advantages are that it could increase the distance of distal margins,reduce the positive rate of circumferential margins,and improve the quality of total mesorectal excision.As few high-quality clinical studies have been conducted,the limitations brought about by confounding bias and publication bias that could not be excluded in current published studies call for a cautious interpretation of the current conclusions.At this stage taTME is only recommended in highly selective patients and centers.Under these circumstances,we aim to discuss the quality assessment of the taTME procedure and the selection of patients and centers.Based on current evidence and practical experience,we typically select patients with difficult pelvis,low rectal cancer,and/or those requiring direct visual recognition of the distal margin after neoadjuvant chemoradiation to perform taTME in our center.
作者
李珂璇
肖毅
Li Kexuan;Xiao Yi(Division of Colorectal Surgery,Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2024年第6期564-568,共5页
Chinese Journal of Gastrointestinal Surgery
基金
中央高水平医院临床科研业务费资助(2022-PUMCH-C-027)。
关键词
直肠肿瘤
经肛全直肠系膜切除术
手术质量控制
Rectal neoplasms
Transanal total mesorectal excision
Surgical quality control
