Transanal mesorectal excision: early outcomes in Australia and New Zealand

Abstract

Background Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand. Methods Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed. Results A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m2. The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months. Conclusion This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery.

Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes

“…Specifically for TaTME, the observed positive CRM rates were lower than the 12.7 per cent encountered in Norway which led to a local recurrence rate of 11.6 per cent and a halt on TaTME in that country 41 . The observed CRM rates in the present study are comparable with the results from early adopters in Australia and the Netherlands, which showed local recurrence rates to be 2-4 per cent 11,42 .One of the most important parameters in assessing the quality of each technique is whether a radical resection can be achieved, with complete resection of the mesorectum. The overall number of incomplete specimen in this…”

Robotic total mesorectal excision or transanal total mesorectal excision meta‐analysis

“…20 The Australasian TaTME surgeons also reported similar rate of local recurrence, with 2.9% involved CRM and only 1.9% local recurrence rate over a 22-month follow-up. 21 At this current juncture, there are now four techniques for rectal cancer surgery, with conflicting evidence on the equivalence of laparoscopic to open TME. There are also no published studies directly comparing Robotic TME and TaTME.…”

Utilization of a transanal approach to facilitate beyond total mesorectal excision dissection including en bloc subcortical high sacrectomy for locally recurrent rectal cancer

“…TaTME was described with main purported advantages in low or bulky rectal tumours in patients with unfavourable pelvic anatomy 3 . Noting the learning curve difficulties and oncological compromise experienced in both Norwegian and Dutch studies, 4,5 these were not borne out in the Australasian series and, hence, we cautiously advocate for this approach in a highly specialized setting 6 . Moreover, the authors have previously published on the application of taTME in complex oncological scenarios such as beyond TME surgery for LARC 2 …”

“…3 Noting the learning curve difficulties and oncological compromise experienced in both Norwegian and Dutch studies, 4,5 these were not borne out in the Australasian series and, hence, we cautiously advocate for this approach in a highly specialized setting. 6 Moreover, the authors have previously published on the application of taTME in complex oncological scenarios such as beyond TME surgery for LARC. 2 Subcortical sacrectomy techniques have emerged as alternatives to total sacrectomy with reduced morbidity, while facilitating high rates of complete pathological resection.…”