Curative Effective Analysis Of TEM And Postoperative Radiotherapy In The Treatment Of Rectal Cancer

Objectives To explore the clinical efficacy of rectal cancer that transanal endoscopic microsurgery(TEM) combined with postoperative radiotherapy.Methods The study retrospectively collected 117 patients of medical records from the gastrointestinal surgery of Tangshan people's Hospital in the past three years(2012.1-2014.12). Patients with rectal cancer were treated by transanal endoscopic microsurgery(hereinafter referred to as the TEM group) or laparoscopic radical resection of rectal cancer surgery(hereinafter referred to as the laparoscopic group). The TEM group had 32 patients, another group had 85 patients(Laparoscopic anterior resection of rectal cancer in 59 cases and 26 cases of laparoscopic resection of rectal cancer by abdominal perineal resection). Statistically analyzed all the patients by the general information(age?gender), lesion characteristics(the maximum diameter of the tumor?distance between tumor and anus), average time of operation, postoperative anal time start exhaust time and length of hospital stay, postoperative anal time start exhaust time, tumor recurrence and metastasis, survival time.Results In the common information, there was no statistical significance difference in distribution of age and gender among the two groups(t=-1.530, P=0.129; X2=0.235, P=0.628). The difference between the two groups had no statistical significance in distribution of the largest diameter of tumor and tumor distance from anal verge position(t=-0.861, P=0.391; t=0.623, P=0.535). All the patients had been completed the operation successfully(TEM group of 32 cases of patients had complete excision of the lesion; in another group, 85 patients underwent laparoscopic total mesorectal excision). There were no patients who were transferred to other operations during the operation. Two groups of patients with the average of operation time was 64.22±15.35min?137.06±48.20min; postoperative anal time start exhaust time was 49.50±10.88h?76.52±14.42h; the average length of hospital stay were 7.47±1.44 d ? 15.59±2.75 d. In the comparison of anus exhausting time, average time of operation and the average length of hospital stay, the difference between the two groups had statistical significance(P=0.000; P=0.000; P=0.000). In the comparison of the bleeding, TEM group was less than the laparoscopic group. The difference between the two groups had statistical significance(P=0.000). No perforation occurred in both groups. In the TEM group, there was one case of patients appeared slight pain in the anus region, which was token nothing special treatment and recovered naturally. There was 1 case of patients appeared postoperative urinary retention, which improved after the treatment of urethral catheterization. In the laparoscopic group, there were 5 case of patients appeared postoperative urinary retention, which improved after symptomatic treatment. There were 2 cases of patients with anastomotic bleeding after surgery, after conservative treatment was not bleed again. There were 5 cases of patients appeared anastomotic leakage, which healed after conservative treatment by intraperitoneal irrigation. There were 5 case of patients appeared anal incontinence that controlled ability was poor, which were improved after symptomatic treatment. In the laparoscopic group, there were 2 cases of patients(in 26 patients with permanent fistula) appeared infection of anterior sacral incision, 1 case of patients with lung infection and 2 cases of patients with urinary tract infection, which healed after the treatment of anti infection. There were 6 male patients appeared sexual dysfunction. Follow-up time until January 2016, two groups of patients are in the process of follow-up, no lost to fellow-up, no deaths occurred, the TEM group does not appear tumor recurrence and metastasis. In the laparoscopic group, 1 case(follow-up in the 31 months) appeared local recurrence with liver metastasis and 1 case(follow-up in the 22 months) with liver metastasis. In the TEM group, there were 2 case of postoperative complications(6.25%). In the laparoscopic group, there were 26 cases of postoperative complications(30.59%). The difference between the groups had statistical significance(X2=7.565, P=0.006). In the TEM group, all patients received radiotherapy after the operation.Conclusions 1 Compared with laparoscopic radical resection of rectal carcinoma, transanal endoscopic microsurgery(TEM) has the advantages of shorter operation time, less bleeding, fewer postoperative complications, rapid recovery and shorter hospital stay in the treatment of rectal cancer. 2 Transanal endoscopic microsurgery(TEM) combines with postoperative radiotherapy for rectal cancer(T1) can achieve the same clinical efficacy of laparoscopic radical resection of rectal cancer, meanwhile avoid permanent colon fistula and reduce postoperative defecation, dysuria and sexual dysfunction or other, which significantly improves patients quality of life. 3 Transanal endoscopic microsurgery(TEM) combines with postoperative radiotherapy for rectal cancer(T1) is safe and reliable, which can achieve the same clinical efficacy of laparoscopic radical resection of rectal cancer.