Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

Abstract

Background Transanal TME (TaTME) was introduced to improve access to the pelvis in difficult cases (male sex, obesity and mid to low rectal cancers) and reduce the risk of anastomotic leak by avoiding cross stapling. In April 2018 the Norwegian hospital to whom all local; recurrences for rectal cancer are referred reported an unexpected rise in early multifocal local recurrences of 9.5% following TaTME compared with 3.4% following conventional TME leading to a nationwide moratorium on the procedure and ending, in an editorial published on the British Journal of Surgery in August 2020, by saying that other countries should consider the issue in the context of local practices and results. There are limited data concerning oncological outcomes of TaTME compared to conventional TME. The aim of this study was to report perioperative and oncological outcomes for patients with rectal cancer treated with TaTME in a high-volume, experienced UK centre. Methods From January 2015 to January 2020 consecutive patients with histologically confirmed rectal cancer having TaTME at Worcestershire Royal Hospital NHS were prospectively entered into an online international registry. Patients were followed according to local protocol with clinical examination, tumour markers, endoscopy and radiology. Results Seventy patients underwent TaTME for rectal cancer. The median distance of the tumour from the anorectal junction was 4 cm (IQR 2-5). The mesorectal margin was involved in 20 (1%) patients, all of whom received neoadjuvant chemoradiotherapy. Overall survival was 94% at a median follow-up of 15 months (IQR 9-31 months). Distant recurrence occurred in 12 (17%) of patients at a median of 14 months (IQR 10-17 months). The 18-month stoma-free survival rate was 66%. Conclusions A local recurrence rate of 5.7% supports the oncological safety of TaTME for rectal cancer.

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: A study of short- and long-term outcomes of 127 consecutive patients from a single Japanese institution

“…In another study by Munini et al [18], the frequency of Clavien-Dindo classi cation grade ≥ 2 was 28.9% in TaTME patients, while grade ≥ 3 classi cations were absent. In contrast, Hallam et al [19] reported more favorable outcomes: postoperative complications (Clavien-Dindo classi cation grades ≥ 2 and ≥ 3) occurred in 14% (10/70 patients) and 11% (8/70 patients) of patients, respectively. In a recent systematic review and meta-analysis by An et al [20], the overall morbidity of TaTME was 30%, including leakage at 6.8%.…”

“…Leakage is a critical issue in transanal down-to-up rectal dissection procedures. Previous studies have reported an anastomotic leakage rate of between 5.5-17.9% [17][18][19][20][21]23].…”

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 127 consecutive patients from a single Japanese institution

“…In another study by Munini et al [18], the frequency of Clavien-Dindo classi cation grade ≥ 2 was 28.9% in TaTME patients, while grade ≥ 3 classi cations were absent. In contrast, Hallam et al [19] reported more favorable outcomes: postoperative complications (Clavien-Dindo classi cation grades ≥ 2 and ≥ 3)…”

“…Leakage is a critical issue in transanal down-to-up rectal dissection procedures. Previous studies have reported an anastomotic leakage rate of between 5.5%-17.9% [17][18][19][20][21]23].…”

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 123 consecutive patients from a single Japanese institution

“…In another study by Munini et al [ 20 ], the frequency of Clavien–Dindo classification grade ≥ 2 was 28.9% in TaTME patients, while grade ≥ 3 classifications were absent. In contrast, Hallam et al [ 21 ] reported more favorable outcomes: postoperative complications (Clavien–Dindo classification grades ≥ 2 and ≥ 3) occurred in 14% (10/70 patients) and 11% (8/70 patients) of patients, respectively. In a recent systematic review and meta-analysis by An et al [ 22 ], the overall morbidity of TaTME was 30%, including leakage at 6.8%.…”