Rate of local recurrence in a cohort of 125 patients treated by transanal total mesorectal excision due to rectal cancer

Abstract Objective Transanal total mesorectal excision (taTME) is an alternative to conventional TME owing to its reported superior ability to achieve clear resection margins in low rectal cancers. Yet, nationwide Norwegian data claimed a 12-month local recurrence rate of up to 10%, a three-fold increase compared to conventional TME, questioning the oncological safety of taTME. Methods Consecutive patients with low rectal cancer treated by taTME were prospectively included. Patients who required a partial mesorectal excision were excluded. Perioperative outcomes were reported as median and interquartile range (IQR). Data were independently audited and certified. Results 125 patients (88 men : 37 women) with a low rectal cancer (7 cm to anal verge, IQR 5-9) underwent a taTME. Age and body mass index were 65 years (IQR 56-76) and 26 kg/m2 (IQR 23-29). 87 (70%) patients had neoadjuvant radiochemotherapy. Surgery time was 357 minutes (IQR 303-435), including an ileostomy in all patients. 1 patient (0.8%) required a conversion to laparotomy. Performing taTME in a 2-team technique saved 94 minutes or 19% operating time (p < 0.005, t-test one-team (n = 52, 420 minutes, IQR 349-494) vs. 2-team (n = 73, 326 minutes, IQR 285-372). 30-day morbidity amounted to 36% minor complications (Dindo Clavien I-II) and 25% major complications (Dindo Clavien III-V), including 11 anastomotic leaks (9%) and 3 reoperations (3%). Most of the leaks could be managed endoscopically and the ileostomy reversed at last. Median length of hospital stay was 10 days (IQR 8-14). Median follow-up was 45 months (IQR 25-67; range 13-95). Dissection of the mesorectum was excellent (Quirke 1 incomplete mesorectal excision rate: 1.6%) with 100% clear margins (distal margin 16mm, IQR 10-30; circumferential margin 10mm, IQR 5-15). Median T stage was 3 (IQR 2-3). 24 patients had positive lymphnodes (median 27, IQR 21-38). Local recurrence occurred in 7 (6%) patients and development of metachronous metastasis was present in 36 (29%) patients. This led to a 5-year disease-free survival of 56% and a 5-year overall survival of 86%. Conclusion Transanal total mesorectal excision allows good surgical and oncologic quality to the expenses of a reasonable surgery time and morbidity.

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Transanal total mesorectal excision for rectal cancer: a multicentric cohort study

Gastroenterology Report ◽

10.1093/gastro/goz049 ◽

2019 ◽

Vol 8 (1) ◽

pp. 36-41 ◽

Cited By ~ 6

Author(s):

Liang Kang ◽

Yuan-Guang Chen ◽

Hao Zhang ◽

Hong-Yu Zhang ◽

Guo-Le Lin ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Anal Verge ◽

Survival Rates ◽

Operating Time ◽

Disease Free Survival ◽

Oncologic Outcomes ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Kaplan Meier

Abstract Background Transanal total mesorectal excision (taTME) has recently emerged as a promising novel surgical procedure for rectal cancer. It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results. This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals. Methods A total of 211 patients were enrolled in this study. Variables for evaluation of safety, feasibility, and oncologic outcomes were retrospectively collected and analysed. Results The median distance between the tumor and the anal verge was 5.9 cm (range, 1.5–12 cm). The median operating time was 280 min (range, 70–600 min) and the median estimated intra-operative blood loss was 50 mL (range, 10–1,500 mL). The overall rate of complication was 27.9%. Among the 211 patients, 175 (82.9%) had complete TME and 33 (15.6%) had near complete TME. The circumferential resection margin was negative in 97.7% of patients. The patients were followed for a median of 35 months (range, 2–86 months). There was 7.6% (16) mortality, 6.2% (13) had local recurrence, and 12.8% (27) had systemic recurrence. Kaplan–Meier survival analysis showed that 1-, 2-, and 3-year disease-free survival rates were 94.8%, 89.3%, and 80.2%, respectively, and 1-, 2-, and 3-year OS rates were 97.4%, 95.7%, and 92.9%, respectively. Conclusions Although limited by its retrospective nature, taTME was safe and feasible in selected patients. Future work with rigorous data recording is warranted.

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Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision for Rectal Cancer

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000002110 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Hans H. Wasmuth ◽

Mahir Gachabayov ◽

Les Bokey ◽

Abe Fingerhut ◽

Guy R. Orangio ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Methodological Evaluation

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Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12385 ◽

2020 ◽

Vol 4 (6) ◽

pp. 628-634

Author(s):

Seiichiro Yamamoto

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Robotic Surgery ◽

Total Mesorectal Excision ◽

Systematic Reviews ◽

Open Surgery ◽

Perioperative Outcomes ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Overview Of Systematic Reviews

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Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1744-z ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Wanglin Li ◽

Boye Dong ◽

Baifu Peng ◽

Jiabao Lu ◽

Zixin Wu ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Hospital Stay ◽

Single Port ◽

Low Rectal Cancer ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Single Port Laparoscopy ◽

The Mean

Abstract Purpose Glove single-port laparoscopy-assisted transanal total mesorectal excision (TaTME) has been successfully carried out in our medical center. The purpose of this study is to evaluate the feasibility of this emerging operation. Methods This technique was performed by self-made glove single-port laparoscopic platform to radically resect low rectal cancer. Short-term postoperative results, including complications, length of hospital stay, and follow-up results were collected and analyzed statistically. Results There are five consecutive patients (three males, two females) who underwent this surgery and included in this study. The mean distance from the tumor to the anal verge was 4.8 cm (range 4.0–6.0). The surgery was completed in all cases, and the rectal tumor was removed successfully without conversion; circumferential margins of all the excised specimens were negative. The mean time of operation was 338.00 min (range 280–400). The average number of lymph node dissection was 12.20. The average postoperative hospital stay was 8.60 days. During the follow-up (14.80 ± 1.92 months), all preventive ileostomies were successfully closed in about 3 months after the surgery, all patients had satisfactory anal function, and no tumor recurrence was found. Conclusion Glove single-port laparoscopy-assisted TaTME has a significant effect in specific patients with low rectal cancer, with rapid recovery and high safety. Prospective randomized studies involving more case counts and long-term follow-up results, especially oncologic outcomes, are needed to validate this technique.

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