Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes (original) (raw)
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Comparison of transanal versus laparoscopic total mesorectal excision in low rectal cancer
Annals of Colorectal Research, 2020
Background: Transanal Total Mesorectal Excision (TaTME) presented in recent years as a novel technique to achieve better outcome in circumferential margin (CRM) and distal margin (DRM) in lower rectal cancer operation. The current study aimed to assess the perioperative and pathological characteristics of TaTME in comparison with laparoscopic total mesorectal excision (LaTME) in patients with mid- and low-rectal cancer. Methods: From January 2016 to December 2018, we enrolled all consecutive patients with rectal cancer, who underwent TaTME and LaTME. Primary endpoints like circumferential rectal margin (CRM) status, distal rectal margin (DRM) status, and pathological outcomes, as well as secondary endpoints including perioperative outcomes (total blood loss, duration of hospitalization, anastomosis leakage, as well as 30-day mortality) were evaluated and compared statistically (α=0.05). Results: 11 patients with distal rectal adenocarcinoma which was biopsy-proven, underwent TaTME, ...
Surgical Endoscopy, 2015
Introduction Total mesorectal excision (TME) is an essential component of surgical management of rectal cancer. Both open and laparoscopic TME have been proven to be oncologically safe. However, it remains a challenge to achieve complete TME with clear circumferential resections margin (CRM) with the conventional transabdominal approach, particularly in mid and low rectal tumours. Transanal TME (TaTME) was developed to improve oncological and functional outcomes of patients with mid and low rectal cancer. Methods An international, multicentre, superiority, randomised trial was designed to compare TaTME and conventional laparoscopic TME as the surgical treatment of mid and low rectal carcinomas. The primary endpoint is involved CRM. Secondary endpoints include completeness of mesorectum, residual mesorectum, morbidity and mortality, local recurrence, disease-free and overall survival, percentage of sphincter-saving procedures, functional outcome and quality of life. A Quality Assurance Protocol including centralised MRI review, histopathology re-evaluation, standardisation of surgical techniques, and monitoring and assessment of surgical quality will be conducted. Discussion The difference in involvement of CRM between the two treatment strategies is thought to be in favour of the TaTME. TaTME is therefore expected to be superior to laparoscopic TME in terms of oncological outcomes in case of mid and low rectal carcinomas.
BMC Surgery, 2019
Background: Aim of this study was to evaluate functional outcomes of transanal total mesorectal excision (TaTME) in comparison to conventional laparoscopic approach (LaTME) in terms of low anterior resection syndrome (LARS). Methods: Forty-six patients who underwent total mesorectal excision for low rectal cancer between 2013 and 2017 were enrolled. Primary outcome was the severity of faecal incontinence, assessed both before the treatment and 6 months after ileostomy reversal. LARS score and Jorge-Wexner scale were utilized to analyze its severity. Results: Twenty (87%) from TaTME and 21 (91%) from LaTME group developed LARS postoperatively. There were no significant differences between groups in terms of LARS occurrence (p = 0.63) and severity. The median Wexner score was comparable in both groups (8 [IQR: 4-12] vs 7 [3-11], p = 0.83). Univariate analysis revealed that postoperative complications were a risk factor for LARS development (p = 0.02). Perioperative outcomes, including operative time, blood loss and intraoperative adverse events did not differ significantly between groups either. Five TaTME patients developed postoperative complications, while there were morbidity 6 cases in LaTME group. Quality of mesorectal excision was comparable with 20 and 19 complete cases in TaTME and LaTME groups, respectively. Conclusions: TaTME provided comparable outcomes in terms of functional outcomes in comparison to LaTME for total mesorectal excision in low rectal cancers. Having said that, LARS prevalence is still high and requires further evaluation of the technique.
Journal of Surgery, 2016
Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients' demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.
Simultaneous laparoscopic abdominal and transanal excision for low rectal tumours
Surgical Practice, 2007
In performing laparoscopic sphincter-preserving total mesorectal excision, one of the technical challenges is to obtain an adequate distal mural margin of 2 cm in the case of low rectal tumours. Herein we describe a technique, known as simultaneous laparoscopic abdominal and transanal excision, where an adequate distal margin can be safely achieved at the beginning of the operation. Methods and Results: As the specimen is delivered per anum, the patient can enjoy the full benefits of minimally invasive surgery. Additionally, the simultaneous approach helps to shorten the operating time. The technique was attempted in five patients with radiological T2 or T3 disease, with two patients having received neoadjuvant chemoirradiation. The outcomes of these five patients are presented. Conclusion: As treatment of rectal cancer is increasingly stage dependent, the simultaneous laparoscopic abdominal and transanal excision procedure offers a clear alternative for treating patients with low rectal tumours in this laparoscopic era.
Journal of Clinical Medicine
Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center. Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted. Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented...
Anticancer Research, 2020
Background/Aim: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity. Patients and Methods: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance<96.4 mm (2 points), ymrT stage≥T3b (4 points), and male sex (1 point). Results: The sample was composed of 141 patients, of whom 23 (16.3%) had a difficult L-TME. The EuMaRCS score demonstrated high accuracy in predicting difficult surgery (AROC: 0.806, 95%CI=0.72-0.88), with a cutoff >3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%). Conclusion: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients. A multimodal approach is recommended for the treatment of locally advanced rectal cancer (LARC) of the middle or low rectum (1). This approach includes neoadjuvant chemoradiation therapy (NCRT) and radical surgery, which represents the curative treatment that impacts patient prognosis the most (2-4). The gold standard procedure is a total mesorectal excision (TME) with clear resection margins (5), which is currently performed more frequently via a minimally invasive approach such as laparoscopy (L-TME) (2, 6-9). Several patient-and tumor-related factors can influence surgical difficulty and make surgical outcomes worse. Among these, anatomical constraints (e.g., narrow pelvis), obesity, tumor volume and height have been shown to be associated with more difficult L-TME procedures, namely, longer operative times, blood loss, intraoperative complications, and conversion to open surgery (4, 10-15). Incomplete mesorectal excision or positive resection margins should be considered to indicate unsuccessful surgical treatment because they are associated with a significantly increased risk of both local and systemic recurrence (3, 11, 16-19). Thus, predicting surgical difficulties and adapting the surgical strategy (technique and approach) to the patient and tumor characteristics could impact the probability of achieving optimal surgical outcomes, consequently improving rectal cancer patient survival.
Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision
Current Colorectal Cancer Reports, 2019
Purpose of Review The access of the low rectum is a surgical challenge and, in case of cancer, the outcome of the patient depends on the quality of the surgery. The transanal total mesorectal excision (taTME) is a surgical technique with a combined abdominal and perineal approach. We review the literature for technical aspect of taTME as well as comparisons with other techniques. Recent Findings Comparison with laparoscopic total mesorectal excision and taTME was summarized in a meta-analysis which showed better oncological results with lower circumferential margin involvement and better completeness of the mesorectum. Summary TaTME is a safe approach. All steps of the intervention are well described and should be followed as numerous pitfalls exist. When compared with laparoscopic or robotic TME, the taTME showed to be safe with similar oncological results. Patients known to be difficult, male, obese, with a narrow pelvis, should be considered for the taTME approach.