| Objective:To investigate the clinical effects of transanal total mesorectal excision and intersphincteric resection in the treatment of low rectal cancer,and to compare the oncological and functional prognosis,as well as the safety,efficacy,surgical advantages and disadvantages of the two methods.Methods:Select the patients at China-Japan union hospital of Jilin university between August 2017 and August 2020 were met inclusion and exclusion standard of 43 patients with low rectal cancer.The patients were divided into two groups according to different surgical methods,among which 22 cases underwent transanal total mesorectal excision while intersphincteric resection was performed in 21 cases.The differences between the two groups in gender composition,body mass index,age,tumor stage and tumor differentiation degree were not statistically significant and comparable.Clinical data(routine physical examination,anal function assessment,blood biochemistry,tumor markers,distance between tumor and anus in colonoscopy,operation time,blood loss,postoperative related conditions,pathological conditions,oncology results,anal function results,etc.)of the two groups were statistically collected for comparative analysis.The anus function of the two groups of patients was measured according to LARS scoring system 1 month and 6 months after rectal cancer surgery or ileostomy return surgery,respectively.Results: All patients were successfully followed up,without lost cases,and the mean follow-up time was 24.4 months(4-36 months).The first postoperative food intake time(2.27±0.55 days VS 3.00 ±0.45 days)and the first postoperative ambulation time(2.09±0.87 days VS 3.48±0.51 days)of the transanal total mesorectal excision group were better than those of the intersphincteric resection group,and the differences were statistically significant(P<0.05).Among the non-ostomy patients,the anal function of the transanal total mesorectal excision group was better than that of the intersphincteric resection group at 1 month after operation,and the difference was statistically significant.In terms of operation,operation time(277.73 ± 69.07 minutes VS 242.86 ± 66.40 minutes),surgical blood loss(40.09 ± 23.79 ml VS48.43 ±26.57 ml),surgical complications(ureteral injury,vaginal injury,the sacral bleeding,anastomotic bleeding,anastomotic leakage,anastomotic stenosis,intestinal obstruction,pelvic pain,urinary retention,crissum abscess,infection of incision,deep vein thrombosis)no statistically significant difference.In terms of postoperative pathology,TME principle was followed in both groups.The mean tumor diameter(3.10±0.96 cm VS 3.80±1.72cm),the distance from the distal tumor to the distal resection margin(2.36±0.73 cm VS2.98±1.36cm),the number of lymph nodes detected(14.10±1.19 VS 15.10±1.90),the number of lymph nodes positive(1.45±2.46 VS 0.86±1.56),TNM stage,and the degree of tumor differentiation were not statistically significant.In terms of postoperative anus function,LARS scoring was performed one month after radical resection of rectal cancer for patients without ostomy,and the group of transanal total mesorectal excision was superior to the group of intersphincteric resection,with statistically significant differences.After six months of pelvic floor function training,the two groups achieved satisfactory results in the anus function,the difference was not statistically significant.For patients with stoma,there was no significant difference in anal function between the two groups at 1 month and 6 months after the reconstruction,and the anal function at 6 months after the surgery was better than that at 1 month after the reconstruction.In terms of oncological prognosis,there was no statistically significant difference between the 1 case of recurrence in the transanal total mesorectal excision group and the 2 cases of recurrence in the intersphincteric resection group.The disease-free survival rate(95.5%VS90.5%)at 12 months and 24 months after operation(95.5% VS90.5%).Overall survival at 12 months(100%VS 100%)and 24 months(100%VS 100%)was not statistically significant.Conclusion: Transanal total mesorectal excision and intersphincteric resection have the same effect in the radical resection of low rectal cancer.According to the statistical analysis of this study,Transanal total mesorectal excision is a relatively safe and feasible surgical method,and compared with intersphincteric resection,postoperative feeding is faster and the first time of getting out of bed is faster.There was no significant difference in postoperative complications.In the group of transanal total mesorectal excision,the anal function of patients without stoma one month after operation was better than that of the group of intersphincteric resection.On the basis of retaining the anus,the anal function was guaranteed and the quality of life of patients was improved.After pelvic floor function training,both the two groups achieved satisfactory postoperative anal function.In oncology,transanal total mesorectal excision can achieve the therapeutic effect of radical tumor resection,but the short-term efficacy is not significantly different from that of intersphincteric resection... |
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