Exploring the perioperative outcomes of a sample of successful adopters of transanal total mesorectal excision (taTME) during the learning phase

Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer

“…The implementation phase of the learning curve may affect oncologic outcomes because LR has been reported to be higher in the first 10 cases performed using the transanal TME technique . In the current study, 3 of 22 cases of LR (13.6%) occurred in patients who underwent transanal TME within the initial 10 cases per center; none of these patients had positive margins or incomplete specimens.…”

“…These findings suggest that the remainder of R1 cases, although not explicitly reported, involved the distal margin and therefore may be reflective of technical failure. Furthermore, the proportion of patients who received neoadjuvant chemoradiation was lower than in other transanal TME series (and rectal cancer series in general); only 1 of 12 patients with local recurrences received neoadjuvant chemoradiation despite there being a pathologic T stage of pT3 or above in 10 of 12 patients. Although the Association of Coloproctology of Great Britain and Ireland subsequently released its own cautionary recommendations after the publication of the Norwegian studies, it is unclear whether the aforementioned data reflect technical inadequacies of a series of early cases or constitute a real indictment of the technique given the inherent limitations.…”

“…Recent studies with adequate follow-up to analyze local recurrence (LR) suggest that these surrogates may not be adequate to ensure safety of the technique. Similarly, other studies suggest that LR rates were higher in the first 10 procedures of a surgeon’s experience despite the implementation of a structured national training pathway. In Norway, evidence of increased LR with a concerning multifocal pattern in patients who underwent transanal TME led to a nationwide moratorium on the procedure .…”

Transanal total mesorectal excision for abdominoperineal resection is associated with poor oncological outcomes in rectal cancer patients: A word of caution from a multicentric Canadian cohort study

“…Previous studies have indicated that the learning curve for taTME requires 40–50 cases [26–28], and the implementation phase has an increased risk of LR [29‐30]. In our study, the majority of patients who received taTME‐APR were operated on after the implementation phase apart from two cases at one site (these patients, however, did not develop recurrent disease).…”