| Background: Surgery is an important treatment for colorectal cancer.In recent years,surgical concepts and surgical methods have made considerable progress.One of the major developments in the surgical treatment of colorectal tumors is the popularity of minimally invasive surgery.With the improvement of clinical diagnostic techniques and pathological diagnostic techniques,the early detection rate of early colorectal tumors has been significantly higher than before.The local resection of colorectal tumors has been widely used in clinical practice.Transanal endoscopic microsurgery(TEM))It is an anus-preserving operation method with three features of soft mirror,laparoscope and minimally invasive surgery for resection of tumor via anal route[1].The TEM was developed by Buess and Mentges who were the German doctors from 1980 to 1983,and It was first applied in 1983[2].The TEM started late in China and was introduced into China by Meng Jiaxing et al[3].in 1995.It had developed rapidly in recent years,and the degree of domestic clinical recognition had been further improved.The TEM can accurately and completely remove the tumor,and can remove the rectal tumor to the rectal full-thickness to avoid the damage caused by the laparotomy.With the improvement of equipment and technology,TEM indications have also expanded from rectal adenomas to early rectal cancer,rectal carcinoid,rectal anastomotic stenosis,rectal prolapse,and recto-vaginal fistula[4].Objective: To study the clinical value of transanal endoscopic microsurgery for rectal cancer.Materials and methods: The clinical data of patients undergoing transanal endoscopic microsurgery admitted to the First Hospital of Jilin University from September 2009 to September 2016 were retrospectively analyzed.The tumor stage,tumor size,distance of tumor from the anal verge,the operative time,intraoperative blood loss,postoperative hospital stay,postoperative complications,postoperative local recurrence rate of these patients were analyzed and summarized.Results: There were 337 patients undergoing internal transanal surgery were included in the study.Their average age was 55.9±12.3(17-90)years,the ratio of males and females was 191/146,the tumor diameter was 0.5-8(median value 2.2)cm,and the distance of tumor from the anal verge was 5-20(median value 7.8)cm.The average follow-up time for all patients was 51.8±24.0(15-99)months,the average operation time was 68.5±28.3(35-200)minutes,and the average postoperative hospital stay was 3.0±2.1(1-20)days,and the mean bleeding volum was 5.3±4.0(2-35)ml.There were no deaths in this study,9 patients had postoperative urinary retention,3 patients had postoperative bleeding,1 patient had postoperative perforation,and 1 patient's anal incontinence score greater than 10.The overall complication rate was 4.2 %.Benign adenomas,neuroendocrine tumors,and stromal tumors did not show any recurrence.The recurrence rate of rectal cancer was 4.3%(the follow-up time were 16-76 months)of which 18 cases had no recurrence of p Tis rectal cancer.One of 24 cases of p T1 colorectal cancer recurred(recurrence rate was 4.%).One of 5 patients with p T2 colorectal cancer recurred(recurrence rate 20%),and the recurrence rate was significantly higher than that of p T1 colorectal cancer.The recurrence of the above two cases was local recurrence.Conclusions: The TEM is suitable for rectal benign tumors which the distance of tumor from the anal verge was 5-20 cm.Operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,and postoperative local recurrence rate are superior to traditional transanal local resection.TEM is safe and effective for p Tis and p T1 stage rectal cancer patients.For patients with p T2 rectal cancer,due to the limitations of TEM,it should be used with caution. |
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