gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2020-19-1-21-36gnck-1537Research ArticleСТАТЬЯ НОМЕРАLEADING ARTICLEСРАВНИТЕЛЬНАЯ ОЦЕНКА ЛАПАРОСКОПИЧЕСКОЙ, ОТКРЫТОЙ И ТРАНСАНАЛЬНОЙ МЕЗОРЕКТУМЭКТОМИИ В ХИРУРГИИ РАКА ПРЯМОЙ КИШКИLAPAROSCOPIC, OPEN AND TRANSANAL MESORECTAL EXCISION IN RECTAL CANCER SURGERYХильковЮ. С.KhilkovYu. S.

ул. Саляма Адиля, д. 2, Москва, 123423

Moscow

yurii.hilkov@mail.ruЧернышовС. В.ChernyshovS. V.

Москва

Moscow

МайновскаяО. А.MajnovskayaO. A.

Москва

Moscow

КазиеваЛ. Ю.KazievaL. Yu.

Москва

Moscow

ПономаренкоА. А.PonomarenkoA. A.

Москва

Moscow

РыбаковЕ. Г.RybakovE. G.

Москва

Moscow

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Centre for Coloproctology of the Ministry of Health of RussiaRussian Federation2020210320201912136Copyright © Хильков Ю.С., Чернышов С.В., Майновская О.А., Казиева Л.Ю., Пономаренко А.А., Рыбаков Е.Г., 20202020Хильков Ю.С., Чернышов С.В., Майновская О.А., Казиева Л.Ю., Пономаренко А.А., Рыбаков Е.Г.Khilkov Y.S., Chernyshov S.V., Majnovskaya O.A., Kazieva L.Y., Ponomarenko A.A., Rybakov E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1537ВВЕДЕНИЕ

ВВЕДЕНИЕ: Исследования, посвященные одновременному сравнению 3 методов мезоректумэктомии: лапароскопической, открытой и трансанальной в настоящее время отсутствуют.

ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ: Сравнение качества ТМЭ по Quirke P., оценка циркулярной и дистальной границ резекции, частоты и структуры периоперационных осложнений.

МЕТОДЫ

МЕТОДЫ: Клиническое проспективное исследование с набором пациентов в 3 группы: лапароскопическая ТМЭ (ЛА ТМЭ), открытая ТМЭ (От. ТМЭ) и трансанальная ТМЭ (ТА ТМЭ).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: В исследование включено 88 пациентов, из которых 29 – в группу ЛА ТМЭ, 29 – в группу От. ТМЭ, 30 – в группу ТА ТМЭ. По клинико-демографическим показателям, характеристикам опухоли группы были сопоставимы. Качество удаленного препарата по P.Quirke в группах От ТМЭ, ЛА ТМЭ и ТА ТМЭ, соответственно, Grade 3 у 52%, 59% и 47%; Grade 1 у 17%, 17% и 17%, статистических различий не получено, p=0,67. По частоте позитивных циркулярной и дистальной границ резекции, различий так же не получено, p=0,38. Частота и структура интра- и послеоперационных осложнений не имела различий во всех трех группах.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: Все три методики выполнения тотальной мезоректумэктомии продемонстрировали сопоставимые результаты, как по качеству удаленного препарата, циркулярной и дистальной границам резекции, так и по количеству интра- и послеоперационных осложнений.

INTRODUCTION

INTRODUCTION: there are no studies comparing laparoscopic, open, and transanal mesorectal excision for rectal cancer.

AIM

AIM: to compare quality of total mesorectal excision (TME) according to the P. Quirke protocol, to assess circular resection margins (CRM), to assess distal resection margins (DRM) and perioperative morbidity.

PATIENTS AND METHODS

PATIENTS AND METHODS: prospective study was performed to compare the effectiveness of different methods of TME.

RESULTS

RESULTS: eighty-eight patients were included in the study, 29 – in the laparoscopic (LA TME) group, 29 – in the open TME group, 30 – in the transanal (TA TME) group. The groups were comparable in clinical, demographic and tumor parameters. There was no significant difference between LA TME, open TME and TA TME in quality of mesorectal excision (p=0.67). There was also no significant difference in rates of positive CRM and positive DRM (p=0.38). No significant difference was obtained between intraoperative and postoperative complications rates (p=0.38; p=0.45). CONCLUSION: all three methods of TME showed the same results for quality, circular and distal resection margins and perioperative morbidity.

рак прямой кишкихирургиямезоректумтотальная мезоректумэктомияТМЭлапароскопиятрансанальнаяТА ТМЭrectal cancersurgerymesorectumtotal mesorectal excisionTMElaparoscopytransanalTA TMEReferencesHeald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? The British journal of surgery. 1982;(69):613-616. DOI: 10.1002/bjs.1800691019.Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? The British journal of surgery. 1982;(69):613-616. DOI: 10.1002/bjs.1800691019.Lichliter WE. Techniques in total mesorectal excision surgery. Clinics in colon and rectal surgery. 2015;1(28):21-27. DOI:10.1055/s-0035-1545066.Lichliter WE. Techniques in total mesorectal excision surgery. Clinics in colon and rectal surgery. 2015;1(28):21-27. DOI:10.1055/s-0035-1545066.Quirke P, Steele R, Monson J. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCICCTG CO16 randomised clinical trial. Lancet (London, England). 2009; 9666(373):821-828. DOI:10.1016/S0140-6736(09)60485-2.Quirke P, Steele R, Monson J. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCICCTG CO16 randomised clinical trial. Lancet (London, England). 2009; 9666(373):821-828. DOI:10.1016/S0140-6736(09)60485-2.Heald RJ, Moran B, Ryall R. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Archives of surgery (Chicago, Ill. : 1960). 1998;8(133):894-899. DOI:10.1001/archsurg.133.8.894.Heald RJ, Moran B, Ryall R. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Archives of surgery (Chicago, Ill. : 1960). 1998;8(133):894-899. DOI:10.1001/archsurg.133.8.894.Fleshman J, Branda M, Sargent DJ. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015;13(314):1346-1355. DOI: 10.1001/jama.2015.10529.Fleshman J, Branda M, Sargent DJ. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015;13(314):1346-1355. DOI: 10.1001/jama.2015.10529.Jayne DG, Guillou P, Thorpe H. Randomized trial of laparoscopicassisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007;21(25):30613068. DOI: 10.1200/JCO.2006.09.7758.Jayne DG, Guillou P, Thorpe H. Randomized trial of laparoscopicassisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007;21(25):30613068. DOI: 10.1200/JCO.2006.09.7758.Kang S-B, Jeong S-Y, Park JW. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. The Lancet. Oncology. 2010;7 (11): 637-645. DOI:10.1016/S1470-2045(10)70131-5.Kang S-B, Jeong S-Y, Park JW. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. The Lancet. Oncology. 2010;7 (11): 637-645. DOI:10.1016/S1470-2045(10)70131-5.Pas MH van der, Haglind E, Cuesta M. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet. Oncology. 2013;3 (14):210-218. DOI: 10.1016/S1470-2045(13)70016-0.Pas MH van der, Haglind E, Cuesta M. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet. Oncology. 2013;3 (14):210-218. DOI: 10.1016/S1470-2045(13)70016-0.Stevenson ARL, Solomon MJ, Lumley JW. Effect of LaparoscopicAssisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA. 2015;13(314): 1356-1363. DOI:10.1001/jama.2015.12009.Stevenson ARL, Solomon MJ, Lumley JW. Effect of LaparoscopicAssisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA. 2015;13(314): 1356-1363. DOI:10.1001/jama.2015.12009.Sylla P. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surgical endoscopy. 2010;5(24):1205-1210. DOI:10.1007/s00464010-0965-6.Sylla P. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surgical endoscopy. 2010;5(24):1205-1210. DOI:10.1007/s00464010-0965-6.Lacy A, Tasende M, Delgado S. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. Journal of the American College of Surgeons. 2015;2(221):415-423. DOI:10.1016/j.jamcollsurg.2015.03.046.Lacy A, Tasende M, Delgado S. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. Journal of the American College of Surgeons. 2015;2(221):415-423. DOI:10.1016/j.jamcollsurg.2015.03.046.Maykel JA. Laparoscopic Transanal Total Mesorectal Excision (taTME) for Rectal Cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2015; 10(19):1880-1888. DOI: 10.1007/s11605-015-2876-2.Maykel JA. Laparoscopic Transanal Total Mesorectal Excision (taTME) for Rectal Cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2015; 10(19):1880-1888. DOI: 10.1007/s11605-015-2876-2.Chen C-C, Lai Y-L, Jiang J-K. Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case-Control Study. Annals of surgical oncology. 2016;4(23): 1169-1176. DOI: 10.1245/s10434-015-4997-y.Chen C-C, Lai Y-L, Jiang J-K. Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case-Control Study. Annals of surgical oncology. 2016;4(23): 1169-1176. DOI: 10.1245/s10434-015-4997-y.Perdawood SK, Thinggaard BS, Bjoern MX. Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surgical endoscopy. 2017;32(5):2312-2321. DOI:10.1007/s00464017-5926-x.Perdawood SK, Thinggaard BS, Bjoern MX. Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surgical endoscopy. 2017;32(5):2312-2321. DOI:10.1007/s00464017-5926-x.Perdawood SK, Khefagie GAA. Al Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016; 1 (18):51-58. DOI:10.1111/codi.13225.Perdawood SK, Khefagie GAA. Al Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016; 1 (18):51-58. DOI:10.1111/codi.13225.Persiani R, Biondi A, Pennestri F. Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis. Diseases of the colon and rectum. 2018;7 (61):809-816. DOI:10.1097/DCR.0000000000001063.Persiani R, Biondi A, Pennestri F. Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis. Diseases of the colon and rectum. 2018;7 (61):809-816. DOI:10.1097/DCR.0000000000001063.de’Angelis N, Portigliotti L, Azoulay D. Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbeck’s archives of surgery. 2015;8(400):945-959. DOI:10.1007/s00423-015-1350-7.de’Angelis N, Portigliotti L, Azoulay D. Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbeck’s archives of surgery. 2015;8(400):945-959. DOI:10.1007/s00423-015-1350-7.Denost Q, Loughlin P, Chevalier R.Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux’ randomized trial. Surgical endoscopy. 2018;32(3):14861494. DOI:10.1007/s00464-017-5836-y.Denost Q, Loughlin P, Chevalier R.Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux’ randomized trial. Surgical endoscopy. 2018;32(3):14861494. DOI:10.1007/s00464-017-5836-y.Marks JH, Montenegro GA, Salem JF. Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Techniques in coloproctology. 2016;7(20):467-473. DOI:10.1007/s10151-016-1482-y.Marks JH, Montenegro GA, Salem JF. Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Techniques in coloproctology. 2016;7(20):467-473. DOI:10.1007/s10151-016-1482-y.Veltcamp Helbach M, Koedam TWA., Knol JJ. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surgical endoscopy. 2019;33(1):79-87. DOI: 10.1007/s00464-018-6276-z.Veltcamp Helbach M, Koedam TWA., Knol JJ. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surgical endoscopy. 2019;33(1):79-87. DOI: 10.1007/s00464-018-6276-z.Rasulov AO, Mamedli ZZ, Gordeyev SS. Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Techniques in coloproctology. 2016;4(20):227-234. DOI:10.1007/s10151-015-1421-3.Rasulov AO, Mamedli ZZ, Gordeyev SS. Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Techniques in coloproctology. 2016;4(20):227-234. DOI:10.1007/s10151-015-1421-3.

The authors declare that there are no conflicts of interest present.