Functional outcomes after transanal total mesorectal excision (TaTME): a random forest analysis to predict patients’ outcomes

Abstract

Purpose Anorectal, sexual, and urinary dysfunction are common issues after rectal cancer surgery, although seldom explored. The primary aim of this study was to investigate postoperative anorectal functional results. Methods Patients with mid/low-rectal cancer treated with transanal TME (TaTME) with primary anastomosis with/without diverting stoma between 2015 and 2020 were reviewed and selected if they had a minimum follow-up of 6 months (from the primary procedure or stoma reversal). Patients were interviewed using validated questionnaires and the primary outcome was bowel function based on Low Anterior Resection Syndrome (LARS) scores. Statistical analyses were performed to identify clinical/operative variables correlated with worse outcomes. A random forest (RF) algorithm was computed to classify patients at a greater risk of minor/major LARS. Results Ninety-seven patients were selected out of 154 TaTME performed. Overall, 88.7% of the patients had a protective stoma and 25.8% reported major LARS at mean follow-up of 19.0 months. Statistical analyses documented that age, operative time, and interval to stoma reversal correlated with LARS outcomes. The RF analysis disclosed worse LARS symptoms in patients with longer operative time (> 295 min) and stoma reversal interval (> 5.6 months). If the interval ranged between 3 and 5.6 months, older patients (> 65 years) reported worse outcomes. Finally, no statistical difference was documented when comparing the rate of minor/major LARS in the first 27 cases versus others. Conclusion One-quarter of the patients developed major LARS after TaTME. An algorithm based on clinical/operative variables, such as age, operative time, and time to stoma reversal, was developed to identify categories at risk for LARS symptoms.

A systematic review and meta-analysis of minimally invasive total mesorectal excision versus transanal total mesorectal excision for mid and low rectal cancer

“…Both types of rectal cancer surgery have a certain impact on a patient’s quality of life ( 57 ), mainly LARS ( 58 ). A study suggests that some patients develop severe LARS after TaTME ( 59 ). Another article found a low incidence of mild/severe LARS in patients after TaTME ( 60 ).…”

Conversion rate to open surgery during transanal total mesorectal excision (TaTME) for rectal cancer: a single-center experience

“…We may speculate that this could have improved surgeons’ expertise and positively affected the results. The transanal and transabdominal teams were both lead by two senior surgeons with a wide experience in mini-invasive colorectal surgery [ 15 ]. Both of the conversion-to-laparotomic-approach events occurred after the previously analysed learning phase [ 16 ]; however, it should be noticed that, in our previous analysis, learning curves were focused on the reduction on other adverse events, such as major complications, the anastomotic leakage or failure and the reoperation rate [ 16 ].…”

Clostridium difficile infection after stoma reversal surgery: a systematic review and meta-analysis of the literature

“…Our group recently conducted a retrospective cohort study in a population of patients who underwent stoma reversal surgery after transanal total mesorectal excision (TaTME) for rectal cancer [ 5 ]. This surgical procedure has been adopted in our surgical unit since 2015, and it has become the treatment of choice for mid- and low rectal cancer, achieving successful surgical and functional outcomes [ 18 ]. The higher incidence of CDI in the postoperative period reported in this cohort (4.8%) could be explained by the characteristics of the study population (rectal cancers who underwent neo-adjuvant therapy in 72.2% of the cases and adjuvant therapy in nearly 48.4%), with a consequent delay in stoma closure.…”