Analysis On Safety And Efficacy Of Transanal Excision Combined With Postoperative Chemo-Radiotherapy For T2N0M0 Low Rectal Cancer

[Objective] To investigate the clinical safety and efficacy of transanal excision by endoscopic linear cutters(ENDOPATH)combined with postoperative chemo-radiotherapy in the treatment of T2N0M0 low rectal cancer patients.[Methods] Clinical data of 62 patients with p T2N0M0 low rectal cancer admitted to a 3-grade hospital from January 2014 to December 2019 were retrospectively analyzed.According to the surgical methods,these patients were divided into transanal excision group(TAE group)and radical rectal cancer group.In the TAE group,29 patients underwent transanal local full-thickness excision with ENDOPATH,followed by postoperative chemoradiotherapy.This group consisted of 27 elderly patients who could not tolerate radical surgery and 2 young patients who refused to undergo enterostomy.In the radical rectal cancer group,laparoscopic radical rectal cancer surgeries were performed according to the principal of total mesorectal excision(TME).Since all patients from this group underwent Miles operation,this group was referred to as Miles group for short and 33 patients were contained.Comparative analyses were performed on basic materials,tumor size,tumor distance from anal verge,pathological type,mean surgical duration,time for hospital stay,intraoperative bleeding volume,postoperative exhaust time,time for removal of the urinary catheter,postoperative complications,local recurrence rate,mortality rate,disease free survival(DFS)rate,overall survival(OS)rate,anal function and quality of life(Qo L)between the two groups.[Results] 1.There were no statistical differences in the distribution of age,body mass index(BMI),gender composition,post‐surgery pathological typing,the tumor size and distance of tumor from the anal verge between the TAE group and Miles group(P>0.05).This indicated that the general information of the two groups were comparable.2.The contrastive analysis of mean operation time,hospital stay,intraoperative bleeding volume,postoperative exhaust time,time for removal of the urinary catheter between TAE group and Miles group:Statistical calculation displayed that surgery time(TAE group vs Miles group,37.10±10.83 vs 111.67±31.91 min),the length of hospital stay(TAE group vs Miles group,6.86±1.13 vs 10.70±1.59)d,amount of intraoperative bleeding(30.17±2.63 vs 76.06±13.96)ml,time to postoperative exhaust(20.38±2.80 vs 76.27±6.77)h,the time for removal of urinary catheter after operation(11.66±2.27 vs 107.36±31.40)h in TAE group were significantly lower than that in Miles group(P<0.01).3.Postoperative complications of the two groups: only 1 case of postoperative hemorrhage occurred in the TAE group,which was cured and discharged smoothly after endoscopic hemostasis.And there are 14 patients in Miles group experienced complications,including 1 postoperative bleeding,1 anastomotic fistula,1intestinal obstruction,10 bladder nerve dysfunction,and 1 sigmoidostomy stenosis.The rate of postoperative complication in the TAE group was lower than that in the Miles group,and the differences were statistically significant(3.45% vs 42.42%,P<0.01).4.Comparison about local recurrence rate,mortality rate,DFS rate and OS rate:(1)1patient experienced local recurrence and metastasis after recurrence in each group,leading to their death.The local recurrence rate and mortality rate in the TAE group 3.45% and Miles group 3.03% had no significant difference between the two groups(P>0.05).(2)The one-year DFS rate of both groups were 100%,the three-year DFS rate and OS rate of TAE group were96.55% and that of the Miles group were 96.97%.There was no statistical significance in the three-year DFS rate and OS rate between the two groups(P>0.05).5.Comparison about anal function and Qo L:(1)The anal function of the TAE group,the tranche of anus preservation,was as good after surgeries as before.However,all cases of the Miles group were performed anorectomy with sigmoidostom in the left lower abdominal and fecal incontinence.This indicated that all patients in the Miles group lost anal function while none in the TAE group lost any anal function,and the anal function of former group was significantly worse than that of latter group(P<0.01).(2)The Qo L score of patients in TAE group(111.03±11.53)was obvious higher than that of the Miles group(89.39±8.64),which was statistically significant(P<0.01).[Conclusion] 1.Transanal excision combined with postoperative chemo-radiotherapy can achieve the same clinical efficacy and safety as Miles for patients with T2N0M0 low rectal cancer.2.TAE group not only has obvious advantages of shorter operating time,shorter hospital stays,less intraoperative blood loss,faster postoperative exhaust,shorter use of indwelling urinary catheter,fewer surgical complications,and higher Qo L over Miles group,but also the postoperative indicators,including local recurrence rate,mortality rate,OS rate and DFS rate have no significantly increase.3.For certain elderly T2N0M2 low rectal cancer patients who cannot tolerate radical surgery and young patients who refuse enterostomy,transanal excision combined with postoperative chemo-radiotherapy might be one of the promising treatment.