Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany

Abstract

Background Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. Patients and methods Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan–Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. Results During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien–Dindo 3–4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. Conclusion TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.

Transanal total mesorectal excision: single center study on risk factors for major complications

“…According to the Chinese CTRC database, the reported data from 2022 showed a postoperative overall complication rate of 15.4% for TaTME, which did not show a significant difference compared to traditional laparoscopic TME (13). In a study including 100 TaTME patients, the postoperative complication rate was 32% (14). Similarly, Caycedo-Marulanda et al found a postoperative complication rate of 34% in their study (15).…”

Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A retrospective propensity score-adjusted cohort study

“…After the two worrisome publications, further studies looked even harder at the issue. Fortunately, elevated local recurrence rates were not observed in recent studies, such as the case series published by Simo and Volkel [ 10 , 37 ], the retrospective multicenter study published by Roodbeen [ 38 ], the comparative studies published by Munini and Zeng [ 34 , 35 ], the surveys published by the national database of Denmark and the international taTME registry [ 39 , 40 ], and a new meta-analysis [ 36 ].…”

Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A Retrospective Propensity Score-Adjusted Cohort Study

“…After the two worrisome publications, further studies looked even harder at the issue. Fortunately, elevated local recurrence rates were not observed in recent studies, such as the case series published by Simo and Volkel [10,34], the retrospective multicenter study published by Roodbeen [35], the comparative studies published by Munini and Zeng [31,32], the surveys published by the national database of Denmark and the international taTME registry [36,37], and a new metaanalysis [33].…”