A Clinical Research Of Colonoscopy-assisted Transanal Minimally Invasive Surgery Via Glove Port

BackgroundColorectal cancer is the third most common malignancy in the world,with an annual incidence of about 1.5 million cases and nearly 700,000 death in 2012 were attributed to this cancer,making it the fourth most lethal tumor in terms of mortality.According to data from China's cancer registry,colorectal cancer is fifth in terms of the incidence of cancer and cancer-related mortality in the country.With improvements in diagnosis and treatment technologies,it is now believed that an early rectal tumor,which is pathological stage Tis or low-risk T₁,can be cured by local resection.And the application of colonoscopy has greatly improved the diagnosis rate of early colorectal cancer,and the local resection of rectal tumor has also increased year by year.It is now believed that trans-anal endoscopic microsurgery?TEM?is one of the standard surgical procedures for rectal adenoma and early low-risk rectal cancer resection.However,the surgical instruments required for TEM are expensive and cost nearly 1 million Yuan in China,which limits it's promotion in primary hospitals.Trans-anal minimally invasive Surgery?TAMIS?is a recent internationally initiated transanal minimally invasive partial resection for TEM surgery,but it also has high costoflaparoscopicequipmentandtransanalaccessequipment.Colonoscopy-assisted TAMIS via a glove port?CA-TAMIS-GP?is a surgical procedure we have explored in the clinic.Resection of the rectal tumor is accomplished by using a glove to establish an anal closed platform and replacing the laparoscopic and pneumoperitoneum used in the TAMIS procedure with a colonoscope.In the clinic,we found that the procedure is simple,practical,and economical.It also expands the clinical application of colonoscopy while assisting in the resection of early rectal tumors.To further investigate its clinical efficacy and safety,we compared it with transanal endoscopic microsurgery?TEM?.ObjectiveTo explore the clinical efficacy of CA-TAMIS-GP in the treatment of early rectal tumors.Methods59 patients with early rectal cancer suitable for local resection were randomly divided into treatment group who underwent CA-TAMIS-GP,and control group who underwent TEM.The operation time,intraoperative blood loss,intraoperative and postoperative complications were observed.The postoperative pathological results,postoperative recovery time,hospitalization cost,and follow-up data of the patients were recorded.According to the observation results,the clinical effects of CA-TAMIS-GP for early rectal tumors were summarized,and the clinical application data such as surgical indications,operation steps,precautions,and prevention and treatment of complications were analyzed.ResultsIn both groups,the surgeries were completed successfully,without conversion to a laparotomy or any obvious hemorrhages.In the CA-TAMIS-GP group?n=27?,there were 15 males and 12 females,with a mean age of 57.2?35–72?y.The mean distance from the anal verge of the rectal tumor was 12.6?4–20?cm.The median diameter of the tumor was 2.6?1.5–3.6?cm.The median operative time was 51.1?35–125?min.In the TEM group?n=32?,there were 18 males and 14 females,with a mean age of 55.3?36–75?y.The mean distance from the anal verge of the rectal tumor was 11.9?5–20?cm.The median diameter of the tumor was 2.5?1.7–3.8?cm.The median operative time was 53.7?40–80?min.All the patients recovered well,without obvious postoperative complications,except for four patients in the CA-TAMIS-GP group and three patients in the TEM group who had minor hematochezia,which resolved spontaneously.Three patients in each group had mild fever,which resolved with expectant treatment.There was no statistically significant between-group difference in baseline data or postoperative complications?all P>0.05?.There was no statistically significant difference in the operative times in the two groups?P>0.05?.However,the operative time in the CA-TAMIS-GP group,excluding the equipment preparation time was longer than that in the TEM group?P<0.05?.A major advantage of the CA-TAMIS-GP approach was a dramatic reduction of the cost of the procedure by using simple,readily accessible equipment?P<0.05?.In the histopathological examination,all the specimens had negative margins,with one case of adenocarcinoma diagnosed in each group that was followed up with additional preventive surgery.No recurrence or metastasis was seen in a close follow-up of 6–36 mo.ConclusionThe CA-TAMIS-GP is a new procedure that is safe and effective in patients with early rectal tumor and appears to be more cost effective than TEM.