Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: A case matched study

Ye, Jingwang; Tian, Yue; Li, Fan; Oostendorp, S. E. van; Chai, Yiming; Tuynman, Jurriaan B.; Tong, Weidong

doi:10.1016/j.ejso.2020.11.131

Cited by 13 publications

(15 citation statements)

References 28 publications

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“…Operative outcomes differ in terms of the operative time, the rate of stapled anastomosis, the rate of conversion to open surgery, and the rate of protective loop ileostomy. The operative time was signi cantly shorter, and conversion to open surgery was null, as in previous reports for the TaTME group [31][32][33]. The conversion rate in large clinical trials, including ALaCaRT, ACOSOG, and COLOR II trials, ranged from 9 to 16% [4,6,7].…”

Section: Discussionsupporting

confidence: 62%

Clinical and oncological outcomes of transanal total mesorectal excision considering the embryology along the fascia in rectal cancer patients: a propensity score-matched analysis

Yoshimitsu

Mori

Tanabe

et al. 2022

Preprint

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Purpose Transanal total mesorectal excision (TaTME) remains a challenging technique for rectal dissection. This study aims to evaluate the clinical and oncological outcomes of TaTME, compared to those of the laparoscopic total mesorectal excision (LaTME) in rectal cancer. Methods Using propensity score-matched analyses, we analyzed retrospective data from 134 consecutive patients with rectal cancer who underwent TaTME or LaTME from January 2011 to June 2020 in our hospital. Clinical and oncological outcomes were evaluated. The primary endpoint was the 2-year local recurrence rate. Results Before data analysis, significant group-dependent differences were observed only in the tumor height (p < 0.01). After analysis, preoperative patients’ demographics were similar between the TaTME and LaTME-defined groups. The operative time was significantly shorter in the TaTME group (p = 0.02), and the rates of hand-sewn anastomosis and protective loop ileostomy were significantly higher(p < 0.01). TaTME showed a 29% overall morbidity rate and LaTME 44%. Furthermore, the rate of Clavien–Dindo grade III tended to be lower in the TaTME group (p = 0.07). There were no statistically significant differences in terms of pathological findings, and the 2-year local recurrence rate was similar between the two groups (both 5.9%) Conclusions TaTME based on embryology along the fascia is feasible and seems a safe alternative to LaTME in selected patients with rectal cancer when considering the conversion rate and the operative time.

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Section: Discussionsupporting

confidence: 62%

Clinical and oncological outcomes of transanal total mesorectal excision considering the embryology along the fascia in rectal cancer patients: a propensity score-matched analysis

Yoshimitsu

Mori

Tanabe

et al. 2022

Preprint

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“…Currently, there are few studies that provide long-term follow-up data. The 2- to 3-year OS of TaTME was reported to be between 93.3% and 96.0% [ 24 , 27 , 28 , 29 , 30 ], and these results are similar to those of LapTME. With a mean follow-up time of over 41 months, the 3-year OS in this study showed no significant difference between TaTME and LapTME, which is consistent with previous reports.…”

Section: Discussionsupporting

confidence: 54%

“…The reported LR rate from current studies ranged from 2.6% to 3.8%, and the DFS ranged from 78.8% to 86%, with a median follow-up time of 2–3 years [ 24 , 27 , 28 , 29 , 30 ]. These results were all from observational studies and may be affected by the experience and learning curve of surgeons.…”

Section: Discussionmentioning

confidence: 99%

Transanal Total Mesorectal Excision (TaTME) versus Laparoscopic Total Mesorectal Excision for Lower Rectal Cancer: A Propensity Score-Matched Analysis

Lin

Kuo

You

et al. 2022

Cancers

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Studies have reported positive short-term and histopathological results of transanal total mesorectal excision (TaTME) for mid-low rectal cancer. The long-term oncological outcomes are diverse, and concerns regarding the high local recurrence (LR) rate of TaTME have recently increased. We retrospectively analyzed 298 consecutive patients who underwent Laparoscopic TME (LapTME) or TaTME between January 2015 and December 2019. Propensity score-matching (PSM) was performed with patients matched for demographics and stage. After PSM, 63 patients were included in each group. The TaTME group had a longer mean operative time (394 vs. 333 min, p < 0.001). The blood loss, diverting stoma rate, and conversion rate were similar. Postoperatively, TaTME and LapTME had compatible complications, recovery, and hospital stay. A similar specimen quality was detected in both groups. After a mean follow-up period of 41–47 months, TaTME had less LR than LapTME (9.5% vs. 23.8%, p = 0.031). The 3-year overall survival was 80.3% in the TaTME group and 73.6% in the LapTME group (p = 0.331). The 3-year disease-free survival (DFS) rate was 72.0% in the TaTME group and 56.6% in the LapTME group (p = 0.038). In conclusion, better DFS and fewer LR events were observed after TaTME; thus, TaTME can be considered a safe and feasible approach in patients with low rectal cancer.

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“…Postoperative complication rates ranging from 21.8% to 46.3% and AL rates ranging from 10.5% to 17.9% have been reported (28)(29)(30)(31). Our 5.1% rate of major postoperative complications was lower than that in other studies (8.6-10.9%) (31)(32)(33). This might indicate that structured training curriculums in China contribute to the acceptable prevalence and severity of postoperative complications, as well as AL.…”

Section: Discussioncontrasting

confidence: 49%

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Xu¹,

Cai²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Transanal total mesorectal excision (TaTME) is an alternative for mid-low rectal cancer. In China, this procedure has been performed in high-volume centers with structured training curriculums. The efficacy of the TaTME structured training curriculums in China is still unclear. This multicenter study aimed to explore the effectiveness of the structured training curriculums in China.Methods: Seven high-volume centers in China participated in this study. The first 25 patients who underwent TaTME in each center were enrolled. In the cohort, patients were divided into 3 groups. The first 5 procedures (group 1) were performed under proctoring according to the requirement of structured training curriculums. The latter 20 cases without proctoring were split into 2 groups (10 cases in each group, groups 2 and 3) according to the order of operation date. The baseline characteristics, perioperative complications, and pathological outcomes were compared between groups 1 and 2, as well as between groups 2 and 3.Results: Symptomatic anastomotic leakage (AL) occurred in 18.6% of the patients in group 2 compared with 5.7% in group 1 (P 1 =0.08) and 5.0% in group 3 (P 2 =0.04). Seven (11.3%) patients in group 2 developed defecation disorders whereas no patients had this complication in group 3 (P 2 =0.02). Compared with group 2, the operative time was shorter (235 vs. 223 min, P 2 =0.40), while the rates of intraoperative complications (15.7% vs. 5.7%, P 2 =0.10), postoperative complications (31.3% vs. 25.7%, P 2 =0.06), AL (20.0% vs. 8.6%, P 2 =0.04), and positive distal resection margin (DRM) (7.5% vs. 2.9%, P 2 =0.27) were lower in group 3. Conclusions:The effect of the structured training curriculums was acceptable but needed further improvement. The prevalence of anastomosis-related complications and the quality control of specimens are still not optimal, and measures for refinement (for example, more cases under proctoring) are needed in the

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Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: A case matched study

Cited by 13 publications

References 28 publications

Clinical and oncological outcomes of transanal total mesorectal excision considering the embryology along the fascia in rectal cancer patients: a propensity score-matched analysis

Clinical and oncological outcomes of transanal total mesorectal excision considering the embryology along the fascia in rectal cancer patients: a propensity score-matched analysis

Transanal Total Mesorectal Excision (TaTME) versus Laparoscopic Total Mesorectal Excision for Lower Rectal Cancer: A Propensity Score-Matched Analysis

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

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