Therapeutic Effect And Related Factors Of TEM In The Treatment Of Early Rectal Cancer

Objective: By analyzing the characteristics of clinical cases of patients with early rectal cancer treated by TEM,the related risk factors for recurrence after TEM were explored.Methods: A retrospective analysis was performed on the clinical data of 73 cases of rectal cancer treated by the same main knife through Transanal Endoscopic Microsurgery(TEM)between June 2009 and January 2015 in the second gastrointestinal surgery department of the First Affiliated Hospital of Fujian Medical University.Cases without remedial treatment included the recording of(1)patient characteristics: age,gender,intraoperative blood loss,length of surgery,postoperative complications,postoperative hospital stay,and hospitalization costs.(2)Tumor:tumor pathological stage,tumor size,tumor distance from the anal margin,tumor location;(3)intraoperative situation: depth of resection(whether full-thickness resection),margin distance from the tumor;(4)postoperative follow-up: local recurrence rate And tumor-free survival rate.Remedial measures,recurrence rates,and follow-up time were recorded in the cases of salvage therapy after TEM.Statistical analysis of the efficacy of the TEM treatment of rectal cancer,related recurrence factors,recurrence of different pathological stages and their treatment.Results: In 73 patients,39 patients(53.4%)were in Tis phase,23(31.5%)were in T1 phase,3(4.1%)were in T2 phase,and 8(11.0%)were rescued after T2 phase surgery.In the case of remedial treatment,65 cases of univariate analysis showed that the tumor pathological stage,depth of resection,distance from the anal verge of the tumor between the recurrence group after TEM and no recurrence group after TEM were statistically significant(P<0.05).However, there was no significant difference in age,gender,maximum diameter of tumor,tumor distance from the anal margin,tumor location,postoperative complications after recurrence of TEM and no recurrence after TEM(P>0.05).Multivariate Logistic regression analysis showed that the pathological stage,depth of resection,and margin distance from the tumor were predictors of recurrence after TEM.The COX proportional hazards model showed that the higher the T-stage,the shallower the resection depth,and the closer the resection margin to the tumor,the higher the postoperative recurrence rate.The Kaplan-Meier curve showed an estimated tumor-free survival time of 85.97 months.The estimated tumor-free survival time at Tis,T1,and T2 were 88.45 months,79.24 months,and 58.00 months,respectively.The tumor-free survival time was shorter in the T2 group than in the TI group and Tis group.Analysis of other literatures showed that the difference in the recurrence rate of T1 and T2 rectal cancer after TEM treatment was statistically significant(P<0.05).There were 8 cases of remedial treatment in T2 phase,1 case had local recurrence and distant metastasis,and the remaining 7 cases had no recurrence.Conclusions: Under strict preoperative screening for patients,TEM can be used as a surgical method for the treatment of early rectal cancer.Postoperative pathological stage,depth of resection and distance from the margin to the tumor are independent risk factors for recurrence after TEM.