Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer  

作　　者：Jie Tan Hong-Li Ji Yao-Wen Hu Zhi-Ming Li Bao-Xiong Zhuang Hai-Jun Deng Ya-Nan Wang Ji-XiangZheng Wei Jiang Jun Yan 

机构地区：[1]Department of General Surgery,Nanfang Hospital,Guangzhou 510515,Guangdong Province,China [2]Department of General Surgery,Southern Medical University,Guangzhou 510515,Guangdong Province,China [3]Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Nanfang Hospital,Guangzhou 510515,Guangdong Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2022年第12期1375-1386,共12页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by the National Natural Science Foundation of China,No.82273360;the Science and Technology Planning Project of Guangzhou City,No.202206010085;the Clinical Research Project of Southern Medical University,No.LC2016PY010;the Clinical Research Project of Nanfang Hospital,No.2018CR034.

摘　　要：BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is essential to achieve R0 resection for low rectal cancer in TaTME,is technically demanding.AIM To assess the feasibility of optical biopsy using probe-based confocal laser endomicroscopy(pCLE)to select the DRM during TaTME for low rectal cancer.METHODS A total of 43 consecutive patients who were diagnosed with low rectal cancer and scheduled for TaTME were prospectively enrolled from January 2019 to January 2021.pCLE was used to determine the distal edge of the tumor as well as the DRM during surgery.The final pathological report was used as the gold standard.The diagnostic accuracy of pCLE examination was calculated.RESULTS A total of 86 pCLE videos of 43 patients were included in the analyses.The sensitivity,specificity and accuracy of real-time pCLE examination were 90.00%[95%confidence interval(CI):76.34%-97.21%],86.96%(95%CI:73.74%-95.06%)and 88.37%(95%CI:79.65%-94.28%),respectively.The accuracy of blinded pCLE reinterpretation was 86.05%(95%CI:76.89%-92.58%).Furthermore,our results show satisfactory interobserver agreement(κ=0.767,standard error=0.069)for the detection of cancer tissue by pCLE.There were no positive DRMs(≤1 mm)in this study.The median DRM was 7 mm[interquartile range(IQR)=5-10 mm].The median Wexner score was 5(IQR=3-6)at 6 mo after stoma closure.CONCLUSION Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer(clinical trial registration number:NCT04016948).

关 键 词：Transanal total mesorectal excision Probe-based confocal laser endomicroscopy Optical biopsy Distal resection margin Low rectal cancer 

分 类 号：R735.37[医药卫生—肿瘤]