Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis

Persiani, Roberto; Biondi, Alberto; Pennestrì, Francesco; Fico, Valeria; Simone, Veronica De; Tirelli, Flavio; Santullo, Francesco; D’Ugo, Domenico

doi:10.1097/dcr.0000000000001063

Cited by 64 publications

(51 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, patients who underwent TaTME were more often diverted during primary surgery. A recent single-centre case-matched study found similar results [25]. This difference might reflect surgeons' perception to protect the anastomosis following the new approach whilst this risk is unsubstantiated.…”

Section: Discussionmentioning

confidence: 81%

Transanal total mesorectal excision: how are we doing so far?

et al. 2019

View full text Add to dashboard Cite

AimThis subgroup analysis of a prospective multicentre cohort study aims to compare postoperative morbidity between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME).MethodThe study was designed as a subgroup analysis of a prospective multicentre cohort study. Patients undergoing TaTME or LaTME for rectal cancer were selected. All patients were followed up until the first visit to the outpatient clinic after hospital discharge. Postoperative complications were classified according to the Clavien–Dindo classification and the comprehensive complication index (CCI). Propensity score matching was performed.ResultsIn total, 220 patients were selected from the overall prospective multicentre cohort study. After propensity score matching, 48 patients from each group were compared. The median tumour height for TaTME was 10.0 cm (6.0–10.8) and for LaTME was 9.5 cm (7.0–12.0) (P = 0.459). The duration of surgery and anaesthesia were both significantly longer for TaTME (221 vs 180 min, P < 0.001, and 264 vs 217 min, P < 0.001). TaTME was not converted to laparotomy whilst surgery in five patients undergoing LaTME was converted to laparotomy (0.0% vs 10.4%, P = 0.056). No statistically significant differences were observed for Clavien–Dindo classification, CCI, readmissions, reoperations and mortality.ConclusionThe study showed that TaTME is a safe and feasible approach for rectal cancer resection. This new technique obtained similar postoperative morbidity to LaTME.

show abstract

Section: Discussionmentioning

confidence: 81%

Transanal total mesorectal excision: how are we doing so far?

et al. 2019

View full text Add to dashboard Cite

show abstract

“…6 Since 2015, this combined transabdominal transanal approach is registered on the mandatory Dutch Colorectal Audit (DCRA). The first published international cohort studies 7,8 and small matched comparative studies [9][10][11][12][13][14] reported promising results for TaTME in rectal cancer, including decreased involved resection margins, lower conversion rates, and morbidity comparable to that with lapTME. It has also been shown that TaTME has a substantial learning curve.…”

mentioning

confidence: 99%

Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score-Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision

Detering

Roodbeen

Oostendorp

et al. 2019

Journal of the American College of Surgeons

View full text Add to dashboard Cite

on behalf of the Dutch ColoRectal Cancer Audit Group BACKGROUND: Transanal total mesorectal excision (TaTME) is a relatively new and demanding technique for rectal cancer treatment. Results from national datasets are absent and comparative data with laparoscopic TME (lapTME) are scarce. Therefore, this study aimed to evaluate the initial TaTME experience in the Netherlands, by comparing outcomes with conventional lapTME. STUDY DESIGN: Patients with rectal cancer who underwent curative TaTME or lapTME were selected from the nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 and December 2017. Primary outcome was circumferential resection margin (CRM) involvement. Secondary outcomes included operative details and short-term (<30 days) clinical course. Propensity score matching was performed for 7 factors. RESULTS: There were 3,777 patients included for analysis (TaTME, n ¼ 416, lapTME, n ¼ 3361). Transanal TME was performed in 38 hospitals and lapTME in 90 hospitals. Before matching, the patient category within the TaTME group was technically more challenging in terms of tumor height and preoperative threatened margins. After 1:1 matching, 396 patients were included in each group, with comparable baseline characteristics. Circumferential resection margin involvement was 4.3% after TaTME and 4.0% after lapTME (p ¼ 1.000). Conversion rate was significantly lower in TaTME (1.5% vs 8.6%, p < 0.001). Anastomotic leak rate was not significantly different (16.5% vs 12.2%, p ¼ 0.116). Other postoperative outcomes were also comparable between the groups. Significant independent risk factors for CRM involvement in TaTME were preoperative threatened margin on MRI (odds ratio [OR] 5.48, 95% CI 1.33 to 22.54) and conversion (OR 30.12, 95% CI 3.70 to 245.20). CONCLUSIONS: This first nationwide study shows early experience with adoption of TaTME in the Netherlands. Considering that current data represent initial TaTME experience, acceptable short-term outcomes were demonstrated when compared with the well-established lapTME.

show abstract

“…One thousand two hundred and forty-seven citations were retrieved from the search strategy. Finally, twelve studies [24][25][26][27][28][29][30][31][32][33][34][35] were included in the analysis, with a total of 899 patients (411 patients in TaTME group, 488 patients in LaTME group) ( Figure 1). The characteristics of eligible studies are shown in Table I.…”

Section: Resultsmentioning

confidence: 99%

“…There were six studies [24-27, 31, 34] that reported CRM, eleven studies [24][25][26][28][29][30][31][32][33][34][35] that reported positive CRM, eight studies [24-27, 30, 32-34] that reported DRM and five studies [25,28,31,34,35] that reported positive DRM. No differences were found in these pathological outcomes ( Figure 5).…”

mentioning

confidence: 99%

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Lin

Chen

et al. 2019

Videosurgery and Other Miniinvasive Techniques

View full text Add to dashboard Cite

Introduction: The benefit of transanal total mesorectal excision (TaTME) for mid and low rectal cancer is conflicting. Aim: To assess and compare the short-term outcomes of TaTME with conventional laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer. Material and methods: We searched PubMed, Embase and Cochrane Library databases for studies addressing TaTME versus conventional LaTME for rectal cancer between 2008 and December 2018. Randomized controlled trials (RCTs) and retrospective studies which compared TaTME with LaTME were included. Results: Twelve retrospective case-control studies were identified, including a total of 899 patients. We did not find significant differences in overall intraoperative complications, blood loss, conversion rate, operative time, overall postoperative complication, anastomotic leakage, ileus, or urinary morbidity. Also no significant differences in oncological outcomes including circumferential resection margin (CRM), positive CRM, distal margin distance (DRM), positive DRM, quality of mesorectum, number of harvested lymph nodes, temporary stoma or local recurrence were found. Although the TaTME group had better postoperative outcomes (readmission, reoperation, length of hospital stay) on average, the difference did not reach statistical significance. Conclusions: Transanal total mesorectal excision offers a safe and feasible alternative to LaTME although the clinicopathological features were not superior to LaTME in this study. Currently, with the lack of evidence on benefits of TaTME, further evaluation of TaTME requires large randomized control trials to be conducted.

show abstract

Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis

Abstract: Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes.

Cited by 64 publications

References 26 publications

Transanal total mesorectal excision: how are we doing so far?

Transanal total mesorectal excision: how are we doing so far?

Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score-Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Contact Info

Product

Resources

About