臨床外科77巻2号

2022年02月発行

特集 ガイドラインには書いていない 大腸癌外科治療のCQ—妥当な治療と適応を見直そう

直腸癌に対してtaTMEは従来式の腹腔鏡手術よりも推奨されるのか

著者： 塚田祐一郎¹ 伊藤雅昭¹ 北口大地¹ 長谷川寛¹ 池田公治¹ 寺村紘一¹ 西澤祐吏¹

所属機関： ¹国立がん研究センター東病院大腸外科

ページ範囲：P.177 - P.183

【ポイント】
◆taTMEにより，深く狭い骨盤内においても精緻な手術が可能となる．
◆taTMEの従来式腹腔鏡手術に対する優位性が報告されつつある．
◆現在2つのランダム化比較試験（COLOR Ⅲ Trial，GRECCAR 11 Trial）が進行中である．

参考文献

1）Paty PB, Enker WE, Cohen AM, et al：Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 219：365-373, 1994

2）Schiessel R, Karner-Hanusch J, Herbst F, et al：Intersphincteric resection for low rectal tumours. Br J Surg 81：1376-1378, 1994

3）Heald RJ, Husband EM, Ryall RD：The mesorectum in rectal cancer surgery -- the clue to pelvic recurrence? Br J Surg 69：613-616, 1982

4）Quirke P, Dixon MF, Durdey P, et al：Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2：996-999, 1986

5）Fleshman J, Sargent DJ, Green E, et al：Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246：655-662, 2007

6）Buunen M, Weldkamp R, Hop WCK, et al：Survival after laparoscopic surgery versus open surgery for colon cancer：long-term outcome of a randomised clinical trial. Lancet Oncol 10：44-52, 2009

7）Jayne DG, Guillou PJ, Thorpe H, et al：Randomized trial of laparoscopic-assisted resection of colorectal carcinoma：3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25：3061-3068, 2007

8）Lacy AM, García-Valdecasas JC, Delgado S, et al：Laparoscopy- assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer：a randomized trial. Lancet 359：2224-2229, 2002

9）Kitano S, Inomata M, Mizusawa J, et al：Survival outcomes following laparoscopic versus open D3 dissection for stage Ⅱ or Ⅲ colon cancer（JCOG0404）：a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2：261-268, 2017

10）Bonjer HJ, Deijen CL, Haglind E；COLOR Ⅱ Study Group：A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer. N Engl J Med 373：194, 2015

11）Jeong SY, Park JW, Nam BH, et al：Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy（COREAN trial）：survival outcomes of an open-label, non-inferiority, randomized controlled trial. Lancet Oncol 15：767-774, 2014

12）Stevenson AR, Solomon MJ, Lumley JW, et al：Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer：The ALaCaRT Randomized Clinical Trial. JAMA 314：1356-1363, 2015

13）Fleshman J, Branda M, Sargent DJ, et al：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 314：1346-1355, 2015

14）Buess G, Kipfmüller K, Hack D, et al：Technique of transanal endoscopic microsurgery. Surg Endosc 2：71-75, 1988

15）Atallah S, Albert M, Larach S：Transanal minimally invasive surgery：a giant leap forward. Surg Endosc 24：2200-2205, 2010

16）Lacy AM, Rattner DW, Adelsdorfer C, et al：Transanal natural orifice transluminal endoscopic surgery（NOTES）rectal resection：“down-to-up” total mesorectal excision（TME）--short-term outcomes in the first 20 cases. Surg Endosc 27：3165-3172, 2013

17）Tsukada Y, Ito M, Watanabe K, et al：Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease. Dis Colon Rectum 59：426-433, 2016

18）Muro S, Tsukada Y, Harada M, et al：Spatial distribution of smooth muscle tissue in the male pelvic floor with special reference to the lateral extent of the rectourethralis muscle：Application to prostatectomy and Proctectomy. Clin Anat 31：1167-1176, 2018

19）Muro S, Tsukada Y, Ito M, et al：The series of smooth muscle structures in the pelvic floors of men：Dynamic coordination of smooth and skeletal muscles. Clin Anat 34：272-282, 2021

20）Muro S, Tsukada Y, Harada M, et al：Anatomy of the smooth muscle structure in the female anorectal anterior wall：Convergence and anterior extension of the internal anal sphincter and longitudinal muscle. Colorectal Dis 21：472-480, 2019

21）Shiraishi T, Ito M, Sasaki T,et al：Association between urinary function and resected pattern of the autonomic nerve system after transanal total mesorectal excision for rectal cancer. Colorectal Dis 23：405-414, 2021

22）Enomoto H, Ito M, Sasaki T, et al：Stapled Anastomosis with Reinforced Sutures in Transanal Total Mesorectal Excision for Low Rectal Cancer：A Retrospective Single-Center Study. Dis Colon Rectum, in press

23）Denost Q, Adam JP, Rullier A, et al：Perineal transanal approach：a new standard for laparoscopic sphinctersaving resection in low rectal cancer, a randomized trial. Ann Surg 260：993-999, 2014

24）The 2017 European Society of Coloproctology（ESCP）collaborating group：An international multicentre prospective audit of elective rectal cancer surgery；operative approach versus outcome, including transanal total mesorectal excision（TaTME）. Colorectal Dis 20：33-46, 2018

25）Penna M, Hompes R, Arnold S, et al：Transanal Total Mesorectal Excision：International Registry Results of the First 720 Cases. Ann Surg 266：111-117, 2017

26）Penna M, Hompes R, Arnold S, et al：Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision：Results From the International TaTME Registry. Ann Surg 269：700-711, 2019

27）Larsen SG, Pfeffer F, Kørner H：Norwegian moratorium on transanal total mesorectal excision. BJS 106：1120-1121, 2019

28）Francis N, Penna M, Mackenzie H, et al：Consensus on structured training curriculum for transanal total mesorectal excision（TaTME）. Surg Endosc 31：2711-2719, 2017

29）Hol JC, Burghgraef TA, Rutgers MLW, et al：Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer：a retrospective propensity score-matched cohort study of short-term outcomes. Br J Surg：Online ahead of print. 2021

30）Aubert M, Mege D, Panis Y：Total mesorectal excision for low and middle rectal cancer：laparoscopic versus transanal approach-a meta-analysis. Surg Endosc 9：3908-0919, 2020

31）Moon JY, Lee MR, Ha GW：Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer：a systematic review and meta-analysis. Surg Endosc：Online ahead of print. 2021

32）Imai S, Ito M：A novel surgical training simulator for transanal total mesorectal excision. Tech Coloproctol 24：1163-1168, 2020