Norwegian moratorium on transanal total mesorectal excision

Larsen, Stein Gunnar; Pfeffer, F.; Kørner, Hartwig

doi:10.1002/bjs.11287

Cited by 178 publications

(185 citation statements)

References 9 publications

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“…Recently, the Norwegian Radium Hospital in Oslo reported an unexpected pattern of recurrences occurring early after TaTME; ten local recurrences (9·5 per cent) were diagnosed a median of 11 months after surgery. However, the local recurrence rate at a median of 17 months in the present study (1 of 38, 2·6 per cent) was comparable with that in several systemic reviews.…”

Section: Discussionsupporting

confidence: 74%

“…A factor that may influence sphincter function particularly after TaTME is the prolonged anal dilatation owing to the wide anal platforms that are involved throughout the procedure. Rates of severe low anterior resection syndrome following TaTME vary significantly in the literature, ranging from 10 to 82 per cent, although results were from very small cohorts 30 -32 . Recently, the Norwegian Radium Hospital in Oslo reported an unexpected pattern of recurrences occurring early after TaTME; ten local recurrences (9⋅5 per cent) were diagnosed a median of 11 months after surgery 13 . However, the local recurrence rate at a median of 17 months in the present study (1 of 38, 2⋅6 per cent) was comparable with that in several systemic reviews 11,33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…In April 2018, the Norwegian Radium Hospital in Oslo reported a new, unexpected pattern of recurrences that occurred early after TaTME, giving rise to significant concern; at least ten local recurrences (9·5 per cent) were diagnosed at a median of 11 months after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Transanal total mesorectal excision for locally advanced middle–low rectal cancers

et al. 2019

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Background This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer. Methods Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed. Results Thirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2. Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. Conclusion Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Transanal total mesorectal excision for locally advanced middle–low rectal cancers

et al. 2019

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“…Pontallier et al 40 38 TaTME > 12 9 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 16 (42) 34 LapTME 10 (3-20) (P = 0⋅932) 14 (41) (P = 0⋅936) Kneist et al 41 10 TaTME Baseline…”

Section: Study Characteristics and Quality Controlmentioning

confidence: 99%

“…and †median (range). The International Prostate Symptom Score (IPSS) ranges from 0 to 35, with categories no/mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) complaints. IIEF, International Index of Erectile Function; TaTME, transanal total mesorectal excision; n.r., not reported/not reported correctly; LapTME, laparoscopic total mesorectal excision.…”

Section: Faecal Incontinence Quality Of Life Scalementioning

confidence: 99%

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Heijden

Köeter

Smits

et al. 2020

British Journal of Surgery

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Background Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single‐port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME. Methods A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta‐analysis were pooled using a random‐effects model. Results A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta‐analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment. Conclusion No differences in function were observed between transanal and laparoscopic TME.

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Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer

et al. 2021

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IMPORTANCE Proponents of novel transanal total mesorectal excision (TME) suggest the procedure overcomes the technical and oncologic challenges of conventional approaches for treating rectal cancer. Recently, however, there has been controversy regarding the oncologic safety of the procedure. OBJECTIVE To assess the association of transanal TME with the incidence of local recurrence (LR) of cancer and the probability of remaining free of LR during follow-up. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from 8 highvolume rectal cancer academic institutions from across Canada on all consecutive patients with primary rectal cancer treated by transanal TME at the participating centers. The study was conducted

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Norwegian moratorium on transanal total mesorectal excision

Abstract: A national decision

Cited by 178 publications

References 9 publications

Transanal total mesorectal excision for locally advanced middle–low rectal cancers

Transanal total mesorectal excision for locally advanced middle–low rectal cancers

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer

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