A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer
A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer
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DOI：
10.1111/j.1463-1318.2011.02830.x
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发表时间：
2012-07-01
影响因子：
3.4
通讯作者：
Cunningham, C.
中科院分区：
文献类型：
--
作者：
Ashraf, S.;Hompes, R.;Cunningham, C.
目的经肛门内镜显微手术（TEM）治疗早期直肠癌（ERC），在某些病例中可获得与大手术相似的结果。直肠内超声（ERUS）是术前选择过程的重要组成部分。本研究报告了其准确性和对英国TEM数据库中患者的影响。方法英国TEM数据库包括前瞻性收集的494例患者的数据。通过比较术前T分期与TEM后明确的病理分期，该数据集用于确定术前分期中ERUS的患病率及其准确性。结果494例直肠癌TEM检查中165例行ERUS检查。44.8%的直肠癌分期不准确：32.7%分期过低，12.1%分期过高。在TEM之前接受ERUS的患者与未接受ERUS的患者之间，TEM切除深度或R1率没有显着差异（P = 0.73）。结论在英国，ERUS仅应用于少数行TEM的直肠癌患者，其在真实的世界中的准确性令人失望。
Aim Transanal endoscopic microsurgery (TEM) for early rectal cancer (ERC) gives results similar to major surgery in selected cases. Endorectal ultrasound (ERUS) is an important part of the preoperative selection process. This study reports its accuracy and impact for patients entered on the UK TEM database. Method The UK TEM database comprises prospectively collected data on 494 patients. This data set was used to determine the prevalence of ERUS in preoperative staging and its accuracy by comparing preoperative T-stage with definitive pathological staging following TEM. Results ERUS was performed in 165 of 494 patients who underwent TEM for rectal cancer. It inaccurately staged rectal cancer in 44.8% of tumours: 32.7% were understaged and 12.1% were overstaged. There was no significant difference in the depth of TEM excision or R1 rate between the patients who underwent ERUS before TEM and those who did not (P = 0.73). Conclusion The data show that ERUS is employed in a minority of patients with rectal cancers undergoing TEM in the UK and its accuracy in this Real World practice is disappointing.