Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1375-1386
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1375
Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer
Jie Tan, Hong-Li Ji, Yao-Wen Hu, Zhi-Ming Li, Bao-Xiong Zhuang, Hai-Jun Deng, Ya-Nan Wang, Ji-Xiang Zheng, Wei Jiang, Jun Yan
Jie Tan, Hong-Li Ji, Yao-Wen Hu, Zhi-Ming Li, Bao-Xiong Zhuang, Hai-Jun Deng, Ya-Nan Wang, Ji-Xiang Zheng, Wei Jiang, Jun Yan, Department of General Surgery, Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
Jun Yan, Department of General Surgery, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Jun Yan, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
Author contributions: J Yan and Tan J designed the research study; Tan J, Ji HL, Hu YW, Li ZM, Zhuang BX, Deng HJ, Wang YN, Zheng JX, Wang T, Jiang W, Han ZL, and Yan J performed the research; Tan J, Ji HL, Hu YW, Li ZM, Zhuang BX, Deng HJ, Wang YN, Zheng JX, Wang T, Jiang W, Han ZL, and Yan J analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
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; and the Clinical Research Project of Nanfang Hospital, No. 2018CR034.
Institutional review board statement: The study was reviewed and approved by the Southern Medical University Nanfang Hospital Institutional Review Board (Approval No. NFEC-2017-091).
Clinical trial registration statement: This study is registered at Clinical Trial. The registration identification number is NCT04016948.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yanjunfudan@163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Yan, MD, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Nanfang Hospital, No. 1838 North Guangzhou Road, Guangzhou 510515, Guangdong Province, China. yanjunfudan@163.com
Received: July 16, 2022
Peer-review started: July 16, 2022
First decision: October 30, 2022
Revised: November 13, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 27, 2022
ARTICLE HIGHLIGHTS
Research background

Transanal total mesorectal excision (TaTME) allows patients even with ultra-low 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. Probe-based confocal laser endomicroscopy (pCLE) enables the real-time, in vivo optical biopsy of living tissue, which means it might help making intraoperative real-time diagnosis for suspicious tumor lesions. Therefore, we investigated whether pCLE can provide optical biopsy for DRM selection and help tailored surgery in low rectal cancer.

Research motivation

No studies have investigated the feasibility of optical biopsy using pCLE in the real-time in vivo selection of the DRM during TaTME for low rectal cancer. This study aimed to explore whether real-time in vivo pCLE examination can help surgeons select the DRM accurately and contribute to improving the surgical outcome and oncological and functional prognosis of low rectal cancer after treatment with TaTME. To our knowledge, this is the first study of optical biopsy using pCLE to select the DRM in TaTME for low rectal cancer.

Research objectives

This study investigated whether real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer.

Research methods

The pCLE exaination was used to determine the distal magin during surgery. The final pathological report was used as the gold standard. The diagnostic accuracy of pCLE examination was calculated.

Research results

Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer, with high accuracy and a particularly high negative predictive value. The pCLE examination is convenient, timesaving and easy for surgeons to perform and could thus be promoted as a regular examination for selecting the DRM during TaTME for low rectal cancer.

Research conclusions

Real-time in vivo pCLE examination can provide optical biopsy for distal margin selecting in TaTME for low rectal cancer.

Research perspectives

Real-time in vivo pCLE can be used to determine the distal margin in TaTME surgical procedure for low rectal cancer.