Abstract: Objective:To investigate the clinical efficacy of transanal minimally invasive surgery (TAMIS) with glove method and transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 60 patients with rectal neoplasms who were admitted to the First Affiliated Hospital of Fujian Medical University from March 2015 to May 2017 were collected. There were 34 males and 26 females, aged from 49 to 74 years, with an average age of 62 years. Of the 60 patients, 30 undergoing TAMIS with glove method and 30 undergoing TEM were allocated into TAMIS group and TEM group, respectively. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative short-term complications; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to August 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed by the Mann-Whitney U test.
Results:(1) Surgical situations and postoperative recovery: patients in the two groups underwent surgery successfully. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative semi-fluid diet intake, postoperative anal pain score, duration of postoperative hospital stay and cases with Kirwan classification Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ of anus function at 3 months after surgery were respectively (35±7)minutes, (9±5)mL, (2.7±0.9)days, (2.9±0.6)days, 2.1±0.9, (3.6±1.9)days, 29, 1, 0, 0, 0 in the TAMIS groups and (38±7)minutes, (9±6)mL, (2.5±0.8)days, (2.7±0.7)days, 1.8±0.9, (4.0±2.3)days, 28, 1, 1, 0, 0 in the TEM group, showing no significant difference in the above indicators between the two groups (t=-1.377,-0.099, 0.931, 0.770, 1.418,-0.789, Z=-0.607, P>0.05). Total operation time and treatment expenses were (38±7)minutes and (8 507±1 471)yuan in the TAMIS group, versus (46±7)minutes and (9 551±1 747)yuan in the TEM group, showing significant differences between the two groups (t=-4.628,-2.506, P<0.05). Results of postoperative pathological examination showed negative margin in the two groups. (2) Postoperative short-term complications: of 2 patients with postoperative short-term complications in the TAMIS group, 1 had postoperative urine retention due to preoperative prostatic hyperplasia and was improved after 3 days of bladder training, 1 was diagnosed as sepsis due to postoperative cold and fever at 2 days after operation with escherichia coli detected in blood culture, and the patient was cured after anti-infection treatment. Of 3 patients with postoperative short-term complications in the TEM group, 1 had anal incontinence at 2 days after operation and was improved after 4 days of anus function exercise, 1 had hematochezia and was improved after hemostatic therapy under colonoscopy, 1 had perineal infection and was improved after anti-inflammation. There was no significant difference in the short-term complications between the two groups (P>0.05). (3) Follow-up: patients in the TAMIS group and TEM group were respectively followed up for (17±4)months and (16±3)months, with no significant difference between the two groups (t=0.200, P>0.05). During the follow-up, 1 case of rectal tubular adenoma in the TAMIS group had local tumor recurrence at 1 year after surgery, with a diameter of about 0.5 cm and a distance of about 12 cm from the anal margin. The patient had no recurrence after endoscopic retreatment and was confirmed tubular adenoma by postoperative pathological examination. One patient with poorly differentiated adenocarcinoma in the TEM group was detected mesorectal lymph node metastasis at 6 months after surgery by magnetic resonance imaging examination and underwent laparoscopic radical resection of rectal cancer. The postoperative pathological examination showed no residual cancer cells in the rectum specimen and there was 1 positive in 15 lymph nodes for pathological examination. No tumor recurrence or metastasis occurred by the end of follow-up. There was no significant difference in postoperative tumor recurrence and metastasis between the two groups (P>0.05).
Conclusions:The clinical efficacy of TAMIS with glove method in the treatment of upper-middle rectal neoplasms is comparable to TEM, which is safe and feasible. In addition, the TAMIS with glove method has shorter time and lower treatment expenses.