No abstract

Background: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. Results: In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7⋅6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2⋅4 years was 11⋅6 (95 per cent c.i. 6⋅6 to 19⋅9) per cent after TaTME compared with 2⋅4 (1⋅4 to 4⋅3) per cent in the NCCR (P < 0⋅001). The adjusted hazard ratio was 6⋅71 (95 per cent c.i. 2⋅94 to 15⋅32). Anastomotic leaks resulting in reoperation occurred in 8⋅4 per cent of patients in the TaTME cohort compared with 4⋅5 per cent in NoRGast (P = 0⋅047). Fifty-six patients (35⋅7 per cent) had a stoma at latest follow-up; 39 (24⋅8 per cent) were permanent.Conclusion: Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.

Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

The laparoscopic procedure is at least as good as conventional appendicectomy. Initial laparoscopy reduces the rate of misdiagnosis.

The presence of micrometastases and isolated tumor cells was found to be a prognostic factor for recurrence and disease-free survival. This may have implications for future treatment of stage I/II colon cancer.