| As the technology has matured and costs have decreased,minimally invasive surgery is being used in more hospitals and is becoming increasingly popular for its potential to reduce surgical trauma and improve postoperative outcomes.Since its introduction by Buess in 1983,transanal endoscopic microsurgery(TEM)has grown rapidly worldwide.Transanal endoscopic microsurgery(TEM)is used for the resection of benign and malignant lesions in the lower third of the rectum.Unlike general local excision,the benefits of TEM include reduced surgical trauma,rapid recovery and improved functional outcomes,and significant postoperative outcomes.Fewer hospitals still perform TEM techniques in China,but its use in the treatment of rectal lesions is becoming more common.Objective:The purpose of this study was to retrospectively analyze the clinical data of patients who underwent this procedure,to summarize the experience of this procedure,and to evaluate the effectiveness and safety of its clinical Methods:The clinical data of 68 rectal tumor patients admitted to the Department of Gastrointestinal Surgery of the Second Affiliated Hospital of Nanchang University during January 2020-November 2022 who underwent TEM were collected and retrospectively analyzed for the size of the mass,the distance of the lower edge of the mass from the anus,the operation time,the hospital stay,the amount of intraoperative bleeding,the pathology and stage of the mass,the incidence of postoperative complications and the recurrence rate.Thirty patients with rectal cancer in situ and pT1 stage rectal cancer treated by TEM surgery were included in the TEM rectal cancer group,and 42 patients with early rectal cancer(pTis,pT1 stage)treated by laparoscopic surgery admitted during the same period were collected and included in the laparoscopic group for retrospective analysis.After a rigorous review and adequate communication,this study was approved by the institutional review board and informed consent was obtained from all participants.The surgical technique,postoperative management,and follow-up were performed in a standardized manner.Results:A total of 68 patients treated by TEM were included in the study,41 male patients and 27 female patients,with a mean age of 56.44±15.96(16-87)years,a mean mass diameter of 2.64±1.80(0.5-10)cm,a mean distance of 5.74±2.85(2-12)cm from the lower edge of the mass to the anal verge,a mean operative time of106.04±57.89(78-332)minutes,mean bleeding volume 10.31±14.47(0-50)ml,and mean hospital stay 8.85±4.44(1-20)days.In this study,two of the patients treated by TEM surgery had postoperative blood in the stool,one had a rectovaginal fistula,one had urinary retention,one had anal stricture,and one had diarrhea,for an overall complication rate of 8.82%.Among patients with benign masses,2 cases recurred,both with pathology of rectal adenoma,with a postoperative recurrence rate of 5.26%.Among patients with rectal cancer,there were no significant differences in age,gender,tumor diameter,and tumor distance from the anal verge between the TEM and laparoscopic groups,which were not statistically significant(p>0.05).There were significant differences in mean operative time,mean bleeding volume,mean hospital stay,and postoperative complications(all p<0.05),which were statistically significant.The postoperative follow-up period of rectal cancer patients ranged from 3 months to2 years and lasted for an average of 15 months.Postoperative pathology in the TEM rectal cancer group: 14 cases of carcinoma in situ and 16 cases of pT1 stage rectal cancer,with a postoperative recurrence rate of 6.67%,were all patients with pT1 stage rectal cancer,and recurrence was found at 12 and 6 months of postoperative follow-up,respectively.The postoperative pathology of the laparoscopic group was24 cases of carcinoma in situ and 18 cases of pT1 stage rectal cancer,and no recurrence cases were found at the follow-up.The postoperative recurrence rate was not statistically significant in the two groups(p>0.05).Conclusion:TEM is a safe and feasible surgical treatment for benign lesions of the lower and middle rectum and early rectal cancer,with the obvious advantages of low complications and easy recovery.When used for early rectal cancer(pTis,pT1),it can achieve similar treatment results as other surgical procedures,with greater advantages in terms of surgical bleeding,hospitalization time and surgical costs,lower complications and improved quality of life.However,further randomized controlled trials are needed to confirm the safety and efficacy of TEM and to compare it with other surgical treatments for early rectal cancer. |
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