Transanal endoscopic submucosal dissection in treatment of patients with early rectal cancer
Objective To explore the effect of transanal endoscopic submucosal dissection(ESD)in the treatment of patients with early rectal cancer.Methods Ninety-two patients with early rectal cancer treated at Xuchang Longyao Hospital from August 2020 to August 2022 were selected and were divided into a transanal group and a laparoscopic according to the therapeutic methods,with 46 cases in each group.There were 25 males and 21 females in the transanal group;they were(57.88±5.03)years old;their body mass index was(22.51±1.55)kg/m2;their longest tumor diameter was(2.46±0.31)cm.There were 23 males and 23 females in the laparoscopic group;they were(58.22±5.34)years old;their body mass index was(22.69±1.71)kg/m2;their longest tumor diameter was(2.51±0.33)cm.The transanal group took transanal ESD,and the laparoscopic group laparoscopic surgery.The perioperative indicators,postoperative recovery,and levels of inflammatory indicators[interleukin(IL)-6,1L-8,C-reactive protein(C-reactive protein,CRP)]and tumor markers[carcinoembryonic antigen(CEA)and carbohydrate antigen 724(CA724)]before and after the surgery and prognosis in both groups were observed.The count data were analyzed by x2 test,and the measurement data t test.Results The operation time and intraoperative bleeding volume in the transanal group were less than those in the laparoscopic group[(59.43±5.22)min vs.(82.77±7.35)min and(30.58±4.31)ml vs.(59.79±8.44)ml],with statistical differences(t=17.560 and 20.905;both P＜0.001).The postoperative exhaust time,first feeding time,and hospital stay in the transanal group were shorter than those in the laparoscopic group[(1.85±0.32)d vs.(2.21±0.41)d,(2.01±0.28)d vs.(2.35±0.37)d,and(4.75±0.69)vs.(5.48± 0.72)d],with statistical differences(t=4.695,4.970,and 4.965;all P＜0.001).The serum levels of CRP,IL-6,and IL-8 24 and 72 h after the surgery in the transanal group were lower than those in the laparoscopic group[(39.58±5.42)mg/L vs.(44.76±6.13)mg/L,(58.19±5.62)ng/L vs.(63.77± 7.18)ng/L,(56.79±4.53)ng/L vs.(60.48±4.42)ng/L,(24.55±4.39)mg/L vs.(28.47±5.13)mg/L,(49.35±4.01)ng/L vs.(55.73±5.24)ng/L,and(40.28±4.32)ng/L vs.(48.76±4.11)ng/L],with statistical differences(t=4.294,4.151,3.954,3.938,6.558,and 9.646;all P＜0.001).One year after the surgery,the levels of CEA and CA724 in the transanal group were lower than those in the laparoscopic group[(5.35±1.08)μg/L vs.(5.83±1.11)μg/L and(3.62±0.54)IU/ml vs.(3.88± 0.58)IU/ml],with statistical differences(t=2.102 and 2.225;P=0.038 and 0.029).One year after the surgery,there was no statistical difference in the recurrence rate between the two groups[0 vs.4.35％(2/46);x2=0.511,P=0.474].Conclusion Transanal ESD in the treatment of patients with early rectal cancer can optimize the operation,reduce blood loss and inflammatory reaction,improve their digestive function,and shorten their postoperative recovery process,and their prognosis is good.
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