4K腹腔镜辅助经肛全直肠系膜切除术联合经括约肌间切除术治疗低位直肠癌的近远期疗效OA

Objective:To investigate the short-and long-term outcomes of 4K laparoscopic transanal total mesorectal excision(TaTME)combining with intersphincteric resection(ISR)in the treatment of low rectal cancer.Methods:A retrospective analysis was conducted on 108 patients with low rectal cancer who were treated at Qiqihar Hospital of Traditional Chinese Medicine from June 2023 to June 2024.They were divided into the control group(n=54)and the observation group(n=54)based on the surgical method.The control group underwent traditional abdominoperineal resection(APR),while the observation group underwent 4K laparoscopic TaTME combined with ISR.Perioperative indicators,postoperative gastrointestinal recovery parameters,pain levels,and incidence of postoperative complications were compared between the two groups.Patients were followed up for one year to compare long-term efficacy and quality of life instruments for cancer patients-colorectal cancer(QLICP-CR)scores.Results:Compared with the control group,the observation group had a longer operative time,less intraoperative blood loss,a shorter postoperative hospital stay,and earlier bowel sound recovery time,first flatus time,and first bowel movement time(P<0.05).There were no statistically significant differences between the two groups in positive resection margin rate,number of lymph nodes harvested,or total incidence of short-term complications(P>0.05).Regarding pain management,there was no significant difference in preoperative numerical rating scale(NRS)scores between the two groups(P>0.05).NRS scores at 1,3,and 7 days after surgery showed a trend of initially incline followed by decline,but scores in the observation group were consistently lower than those in the control group(P<0.05),with a significant interaction between time and group(P<0.05).Oncological outcomes showed that the observation group had lower rates of metastasis and local recurrence,and a significantly higher disease-free survival rate(P<0.05).For quality of life assessment,there was no significant difference in preoperative QLICP-CR scores(P>0.05).Scores at 3,6,and 12 months after surgery gradually increased,with scores in the observation group consistently higher than those in the control group(P<0.05),and the interaction between time and group was significant(P<0.05).Conclusion:Compared with APR,4K laparoscopic TaTME combined with ISR for low rectal cancer,despite a slightly longer operation time,has superior performance in terms of intraoperative blood loss,postoperative hospital stay,gastrointestinal function recovery,and postoperative pain control.Furthermore,it can reduce tumor metastasis and recurrence rates,improve disease-free survival,and enhance patients'long-term quality of life,without increasing the incidence of short-term complications,showing good short-and long-term efficacy.