TaTME与LaTME治疗中低位直肠癌疗效对比的研究进展

Research Progress on Comparison of Efficacy between TaTME and LaTME for Mid-Low Rectal Cancer

摘要: 随着微创技术的发展，经肛全直肠系膜切除术(TaTME)作为腹腔镜全直肠系膜切除术(LaTME)的替代术式，在中低位直肠癌尤其是“困难骨盆”患者中展现出潜在优势。但其与LaTME的疗效对比始终是外科领域的关注重点。本文系统回顾了近年来两者在围术期安全、肿瘤学结局及功能学预后三个维度的对比研究，发现在围术期安全方面两者总体并发症与吻合口漏发生率相当，且TaTME中转率显著更低；在肿瘤学结局方面TaTME的根治性切除率、局部复发及长期生存非劣效于LaTME；在功能学预后方面两种术式在肛门功能、泌尿功能和总体生活质量上基本相当，但功能损害的普遍性和评估工具的局限性需特别关注。然而，多数研究仅聚焦于单一维度，目前尚缺乏涵盖上述三方面的综合评价体系。因此，本文旨在从“三位一体”的整合视角系统评价TaTME与LaTME的疗效差异，以期为临床医生选择最佳术式、实现患者整体利益最大化提供全面的依据与决策参考。

Abstract: With the advancement of minimally invasive techniques, transanal total mesorectal excision (TaTME)—as an alternative to laparoscopic total mesorectal excision (LaTME)—has demonstrated potential advantages in mid-low rectal cancer, particularly in patients with a “difficult pelvis”. However, the comparative efficacy of TaTME versus LaTME has remained a focal point of ongoing debate since its introduction. This article systematically reviews recent comparative studies on the two techniques across three dimensions: perioperative safety, oncological outcomes, and functional prognosis. In terms of perioperative safety, the two techniques show comparable overall complication and anastomotic leakage rates, with TaTME demonstrating a significantly lower conversion rate. Regarding oncological outcomes, TaTME is non-inferior to LaTME in radical resection rate, local recurrence, and long-term survival. With respect to functional prognosis, the two approaches yield broadly comparable results in anal function, urinary function, and overall quality of life; however, the high prevalence of functional impairment and the limitations of current assessment tools warrant particular attention. Most existing studies have focused on single-dimensional outcomes, and a comprehensive evaluation system encompassing perioperative safety, oncological outcomes, and functional prognosis is currently lacking. Therefore, this article aims to systematically evaluate the efficacy differences between TaTME and LaTME from an integrated “trinity” perspective, with the goal of providing clinicians with a comprehensive evidence base and decision-making reference for selecting the optimal surgical approach to maximize overall patient benefit.