Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
Objective To investigate whether 3D-guided cone-shaped segmentectomy could achieve comparable long-term outcomes with lobectomy for ≤2 cm deep early-stage lung cancer. Methods We retrospectively screened patients with ≤2 cm deep early-stage non-small cell lung cancer (NSCLC) who underwent lobectomy or segmentectomy at our center from January 2012 to December 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analysis were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1:1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. ResultsOur cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in lobectomy group were significantly higher than those in segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) and overall survival (OS) of patients in segmentectomy group were significantly better than those in the lobectomy group (5-year DFS: 98.64% vs. 89.77%, P<0.001; 5-year OS: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS: HR=0.52 (0.11, 2.59), P=0.427; OS: HR=0.08 (0, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.49 cm and 1.44 cm and the mean consolidation tumor ratio (CTR) of 0.52 and 0.46, respectively. There was no statistical difference in DFS (P=0.640) and OS (P=0.310) between two groups. Conclusion3D-guided cone-shaped segmentectomy could be an acceptable treatment for ≤2 cm low-grade malignant NSCLC deep in lung parenchyma, and its oncology effect was not inferior to lobectomy.