| Objective: The clinical data of 92 cases of T1N0M0 middle and lower rectal cancer were retrospectively reviewed,and the safety and efficacy of transanal partial resection and traditional radical resection were compared and analyzed,which provided a theoretical basis for the choice of early and middle rectal cancer treatment options.Methods: T1N0M0 patients with low and middle rectal cancer who were admitted to the Department of Gastrointestinal Tumor Surgery of the First Affiliated Hospital of Hebei North University from January 2010 to December 2016 were collected.92 cases were completely in compliance with the inclusion criteria.According to different treatment methods,they were divided into two groups:transanal local resection group(group TAE)and rectal cancer radical operation group(group radical operation).Group TAE : a total of 39 cases were resected with laparoscopic cutting and sutures,and the tumor was locally enlarged and resected.Group radical surgery:According to the principle of total mesorectal excision(TME),laparoscopic radical resection of rectal cancer was performed in 53 cases(including laparoscopic Miles surgery and laparoscopic Dixon surgery in 37 cases).General information,postoperative pathological classification,tumor size and location,operation time,length of hospital stay,incidence of postoperative complications,disease free survival(DFS)rate and local recurrence after three years Rate,postoperative anal function and quality of life were compared.Results: 1.There was no significant difference in gender composition,age composition,and pathological type between the group TAE and the group radical operation(all P>0.05);the tumor size and the distance from the anal margin of the group TAE to the group radical operation.There was nosignificant difference in terms of comparison(all P>0.05).The general data of the two groups were not statistically different and comparable.2.Comparison of operation time,hospitalization time and surgical bleeding volume:(1)The operation time of the group TAE(37.74±10.66 min)was significantly shorter than that of the group radical operation(117.66±41.78 min)(P<0.01);The time(6.85 ± 1.06 d)was significantly shorter than that of the group radical operation(10.70±1.72d)(P<0.01).(3)The surgical bleeding volume of the group TAE(30.21 ± 2.97 ml)was significantly reduced compared with the group radical operation(78.96±12.65 ml)(P<0.01).3.Postoperative complications in the two groups: only one case of postoperative bleeding occurred in the group TAE,and hemostasis was successfully stopped by endoscopy,and the patients recovered and were discharged.Complications in the group radical operation included 1 case of postoperative bleeding,1 case of anastomotic fistula,2 cases of intestinal obstruction,18 cases of bladder nerve dysfunction,and 1 case of Miles sigmoid colostomy stenosis.The complication rate in the group TAE was 2.56%(1/39),and the complication rate in the radical operation group was 43.39%(23/53).The incidence of complications in the group radical operation was significantly higher than that in the group TAE,which was statistically significant(P<0.01).4.Three-year DFS and recurrence rate and comparison: There were no tumor-related deaths in both groups.(1)The three-year DFS in the TAE group was 97.43%,and the three-year DFS in the radical operation group was 100%.There was no significant difference in the three-year DFS rate between the two groups(P>0.05).(2)One case recurred in the group TAE,and no recurrence was found in the group radical operation.One patient in the group TAE had a local recurrence 12 months after the operation,and then underwent Dixon.The patients were followed up for two years without recurrence.The recurrence rate in the group TAE was2.56%,and the recurrence rate in the group radical operation was 0%.There was no significant difference in the recurrence rate between the two groups(P>0.05).5.Comparison of anal function and quality of life:(1)39cases(100%)of the group TAE retained the anus,and the anal function was consistent with that before the operation,and the anal function of the entire group was good.In the group radical operation,16 patients underwent anal resection with sigmoid colostomy in the left lower abdomen,and the stool could not be controlled.Dixon operation retained the anus in 37 patients,and the anal sphincter function was not as good as before,but gradually recovered through anal function training.Anastomosis patients still had defecation incontinence for more than 1 year after operation.A total of 18 patients(33.96%)had anal function loss and poor anesthesia in the group radical operation,and 0 in the group TAE.The anal function of the group TAE was significantly better than that of the group radical operation(P<0.01).(2)Compared with the quality of life,the overall health score of the group TAE and the group radical operation was significantly higher in the group TAE(90.31 ± 3.82)than in the group radical operation(71.56±6.33),indicating that the group TAE had high quality of life and the difference was statistically significant(P<0.01).Conclusion: 1.For patients with T1N0M0 early-stage low rectal cancer,transanal partial resection can obtain the same safety and efficacy as traditional radical surgery.2.Transanal local resection has the advantages of short hospital stay,small surgical trauma,and low postoperative complications.It can also avoid colostomy and significantly improve the quality of life of patients.3.Transanal local resection is one of the first choices for early middle-low rectal cancer,especially suitable for the elderly and infirm. |
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