Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study

Chen, Chien-Chih; Lai, Yi‐Ling; Jiang, Jeng-Kae; Chu, Chun-Ho; Huang, I-Ping; Chen, Wei‐Shone; Cheng, Andy Yi-Ming; Yang, Shung‐Haur

doi:10.1245/s10434-015-4997-y

Cited by 114 publications

(122 citation statements)

References 24 publications

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“…Nevertheless, due to its complexity, the usage of different minimally invasive techniques in taTME is associated with a significant rate of intraoperative rectal, vaginal, or bladder injury during the learning curve, mainly due to the anatomical landmarks which are different from those during standard laTME from above. However, beyond the learning curve, the rate of intraoperative complications decreases [26,27,28]. Postoperative outcomes and oncological results of taTME and laTME were reported by several retrospective and comparative studies to be similar.…”

Section: Discussionmentioning

confidence: 99%

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

et al. 2019

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Background: The novel surgical procedure transanal total mesorectal excision (taTME) has rapidly become an interest of research in order to overcome the shortcomings of laparoscopic surgery in the treatment of middle and low rectal cancer. taTME is a new natural orifice transluminal endoscopic surgery modality combining three rectal surgery techniques. Methods: A retrospective clinical study was conducted in a single centre for a period of 3 years, and herein we report on our first 25 taTME procedures in patients with middle and lower third rectal adenocarcinoma. Results: The main demographics were evaluated. The mean age of patients was 64 ± 12 years. There were predominantly males (72%) and 7 female patients (28%) with an average body mass index of 29 ± 4.8 kg/m². High blood pressure, obesity, chronic heart insufficiency, chronic atrial fibrillation, and diabetes mellitus were commonly diagnosed in all patients. A circumferential resection margin >1 mm was achieved in 16% (n = 4), >2 mm in 40% (n = 10), and >3 mm in 44% (n = 11) of operated patients. The average CRM was 1.8 ± 0.9 cm. In 24% of cases, the distance of a tumour from the mesorectal fascia (MRF) was <1 mm; meanwhile, for 76% of patients, the tumour margin was >1 mm from the MRF. Recovery to flatus was 3 ± 1 days. The average length of hospital stay was 11 ± 3 days. The overall postoperative morbidity was 8%, i.e. one (4%) complication classified as Clavien-Dindo degree I and one (4%) major (IIIb) complication. Subsequently, all patients successfully recovered and were discharged from hospital. During the follow-up period no cancer recurrence was observed. Conclusion: Our results nicely demonstrate that taTME can be safely performed with acceptable perioperative complications in patients with middle or lower third rectal cancer. In addition, the perioperative morbidity is also acceptable. However, taTME remains a technically highly demanding operation but is feasible and safe after the appropriate experience is gained. Nevertheless, larger multi-centre prospective randomised studies are ongoing to confirm the safety and to verify oncological results when compared to laparoscopic rectal surgery.

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Section: Discussionmentioning

confidence: 99%

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

et al. 2019

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“…In one study (47), the extent of the distal resection margins was reported as >1cm in 78% after LapTME, and in 77% after TATME. In two studies (44,45), the extent of free distal resection margins was significantly longer after TATME.…”

Section: Minimally Invasive Therapy and Allied Technologiesmentioning

confidence: 94%

“…These patients were enrolled in 33 publications according to three types of clinical studies: case reports (17,(19)(20)(21)(22), clinical case series (retrospective and prospective) (11,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)42), and comparative studies (43)(44)(45)(46)(47)(48)(49).…”

Section: Demographics Of Patients Included In Case Reports and Clinicmentioning

confidence: 99%

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Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

Araújo

Perez²,

Seid

et al. 2016

Minimally Invasive Therapy & Allied Technologies

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Current available evidence regarding transanal total mesorectal excision (TATME) was analyzed including perioperative and immediate oncologic outcomes. A literature search of PubMed, Embase and Cochrane was performed. Thirty-two studies were identified, reporting on 721 patients who underwent TATME. TATME represents a feasible and reproducible technique. Nevertheless, the results of the present review are limited by the design of the included studies, which are mostly case reports and case series. Little is known about long-term oncologic outcomes, intestinal, sexual, urinary function and quality of life after TATME. Multicenter large sample randomized controlled trials are required for further investigation of these issues.

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“…Three recently published non-randomized comparative studies presented conclusions similar to those of our institutional study. While none of these three studies showed any oncological superiority, they did report substantial advantages in short-term outcomes with trans-anal endoscopic proctectomy compared with standard laparoscopy [27–29]. Finally, we performed a single-institution case-controlled comparative study ( n = 72) [30] and found that ETAP could make the procedure easier and improve short-term outcomes without impairing the oncological quality or outcome.…”

Section: Introductionmentioning

confidence: 99%

A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design

et al. 2017

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BackgroundTotal mesorectal excision is the standard surgical treatment for mid- and low-rectal cancer. Laparoscopy represents a clear leap forward in the management of rectal cancer patients, offering significant improvements in post-operative measures such as pain, first bowel movement, and hospital length of stay. However, there are still some limits to its applications, especially in difficult cases. Such cases may entail either conversion to an open procedure or positive resection margins. Transanal endoscopic proctectomy (ETAP) was recently described and could address the difficulties of approaching the lower third of the rectum. Early series and case-control studies have shown favourable short-term results, such as a low conversion rate, reduced hospital length of stay and oncological outcomes comparable to laparoscopic surgery. The aim of the proposed study is to compare the rate of positive resection margins (R1 resection) with ETAP versus laparoscopic proctectomy (LAP), with patients randomly assigned to each arm.Methods/designThe proposed study is a multicentre randomised trial using two parallel groups to compare ETAP and LAP. Patients with T3 lower-third rectal adenocarcinomas for whom conservative surgery with manual coloanal anastomosis is planned will be recruited. Randomisation will be performed immediately prior to surgery after ensuring that the patient meets the inclusion criteria and completing the baseline functional and quality of life tests. The study is designed as a non-inferiority trial with a main criterion of R0/R1 resection. Secondary endpoints will include the conversion rate, the minimal invasiveness of the abdominal approach, postoperative morbidity, the length of hospital stay, mesorectal macroscopic assessment, functional urologic and sexual results, faecal continence, global quality of life, stoma-free survival, and disease-free survival at 3 years. The inclusion period will be 3 years, and every patient will be followed for 3 years. The number of patients needed is 226.DiscussionThere is a strong need for optimal evaluation of the ETAP because of substancial changes in the operative technique. Assessment of oncological safety and septic risk, as well as digestive and urological functional results, is particularily mandatory. Moreover, benefits of the ETAP technique could be demonstrated in post-operative outcome.Trial registrationClinicalTrial.gov: NCT02584985. Date and version identifier: Version n°2 – 2015 July 6.

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Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study

Cited by 114 publications

References 24 publications

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design

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