Comparison Of Transanal Total Mesorectal Excision With Conventional Laparoscopic Surgery In Lower Rectal Cancer Resection

Objective:In recent years,the incidence of rectal cancer is increasing.The main treatment for rectal cancer is surgical treatment,and total mesorectal excision is currently recognized as the gold standard for radical resection of rectal cancer.However,traditional total mesorectal excision is difficult to perform in some conditions,such as narrow pelvis,obese patients,and excision of the perirectal mesentery,which may lead to incomplete resection of the tumor and increase the possibility of positive circumferential resection margin(CRM).Affected by this,the research on transanal total mesorectal excision(Ta TME)has been carried out at home and abroad.Different from the top-down surgical approach of conventional laparoscopic surgery(CLS),this surgical approach adopts a bottom-up transanal approach,and the specimen is removed from the anus after the distal part of the tumor is treated by transanal endoscopy.This study will compare laparoscopic total mesorectal excision(Lap TME)with laparoscopic total mesorectal excision to investigate the efficacy,safety,clinical application value and prospect of laparoscopic transanal total mesorectal excision in the resection of low rectal cancer.Methods:According to the inclusion criteria,a total of 48 patients were enrolled for laparoscopic low rectal cancer resection in our center from July 2019 to December2022.The specific conditions of the two surgical methods should be informed before the operation,and the surgical methods should be decided according to the independent will of the patients and their families,the doctors did not actively interfere in the choice of surgical methods,in proof of signature.The observation group underwent Ta TME surgery.The control group underwent Lap TME.Among them,19 cases underwent Ta TME.Lap TME was performed in 29 cases.According to the exclusion criteria,1 case was excluded in the observation group because of intraoperative conversion to open surgery;In the control group,2 cases were excluded,1 case was diagnosed as adenoma by postoperative pathology and the other was converted to open surgery.Final enrollment:18 patients were enrolled in the observation group;27 patients were enrolled in the control group.We mainly compared whether there were statistical differences in the total operation time,intraoperative blood loss,intraoperative stoma,postoperative first flatus and defecation time,postoperative liquid food intake time,postoperative ambulation time,postoperative abdominal drainage tube removal day,total length of incision,hospitalization time,gastric tube placement,anal preservation rate,intraoperative complications and other surgical results and short-term postoperative surgical effect between the two groups.Results:There were no statistical differences in gender,age,BMI,history of abdominal surgery,ASA classification of anesthesia,distance from tumor to anus,and preoperative complications between the two groups(P>0.05).In terms of surgical results and early postoperative efficacy,there were no statistical differences between the two groups in intraoperative blood loss,intraoperative stoma,the first postoperative exhaust day,the first postoperative defecation day,the day of liquid diet intake,the time of drainage tube removal,the postoperative hospital stay,and postoperative complications(P>0.05).However,there were statistical differences(P<0.05)in the total operation time(observation group: 298.4±88.9 min 228.3±73.3min,P=0.006),total incision length(5.6±1.5 cm in the observation group,11.2±2.1cm in the traditional group;P < 0.001),gastric tube placement(the proportion of patients with no gastric tube placement,removal of gastric tube 1 day after surgery,and removal of gastric tube more than 1 day after surgery in the observation group was 44.4%,44.4%,and 11.1%,respectively,while that in the control group was14.8%,59.3%,and 25.9%,respectively,P =0.032),and ambulation days after surgery(the observation group: 3.1±1.3 days vs 4.3±1.7 days,P=0.016)and sphincter preservation rate(100% vs 55.6%,P <0.001);However,there was no significant difference in pathological stage,tumor diameter,depth of tumor invasion,proximal and distal resection margin,vascular invasion,nerve invasion,number of lymph nodes detected and number of positive lymph nodes(P>0.05).Conclusion:There is no significant difference in safety between laparoscopic transanal total mesorectal excision and laparoscopic total mesorectal excision in low rectal cancer resection.Compared with the latter,it has smaller and more beautiful incision,reduces postoperative trauma while preserving anus,and recovers faster after surgery,which is in line with the concept of enhanced recovery after surgery.The improvement of sphincter preservation rate also improves the postoperative quality of life of patients and reduces the psychological pressure of patients.However,as a new surgical method,it has a high threshold and a long learning curve,and its development in our hospital is still in its infancy.More cases need to be accumulated for further statistical analysis of the long-term efficacy of this surgical procedure.In general,this operation can benefit most patients with low rectal cancer,and it is worthy of our application and promotion.