Association of Plane of Total Mesorectal Excision With Prognosis of Rectal Cancer

Kitz, Julia; Fokas, Emmanouil; Beißbarth, Tim; Ströbel, Philipp; Wittekind, Christian; Hartmann, Arndt; Rüschoff, Josef; Papadopoulos, Thomas; Rösler, Elisabeth; Ortloff-Kittredge, Peter; Kania, U.; Schlitt, Hans J.; Link, Karl-Heinrich; Bechstein, Wolf O.; Raab, Hans-Rudolf; Staib, Ludger; Germer, Christoph‐Thomas; Liersch, Torsten; Sauer, Rolf; Rödel, Claus; Ghadimi, Michael; Hohenberger, Werner

doi:10.1001/jamasurg.2018.1607

Cited by 82 publications

(51 citation statements)

References 42 publications

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“…Fitzgerald et al report that in surgical treatment combined with radiotherapy, the completeness of mesorectal excision and the negative resection margin (regardless of the distance) are the most important factors for oncological outcomes [ 42 ]. Moreover, an up-to-date secondary analysis of CAO/ARO/AIO-04 trial underlines the association between the quality of mesorectal excision and the 3-year overall and disease-free survival, which is more important than the length of the margin [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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IntroductionDespite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters.Materials and methodsPatients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure.ResultsAmong patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210–270 IQR) for APR, 212.5 (170–260 IQR) for intersphincteric resection, and 270 (240–330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4–7 IQR), in intersphincteric resections 7.5 mm (2.5–10 IQR), and in the TaTME group 4 mm (2.8–8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS.ConclusionSphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated.Trial registrationThe study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001).

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Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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“…Currently, one of the leading topics under constant discussion is the quality of mesorectal excision. The most recent study showed an association between plane of mesorectal excision, long-term overall survival and recurrence rate [ 45 ]. In our study, there were no differences between TaTME and LaTME regarding the quality of the specimen.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

Rubinkiewicz

Czerwińska

Zarzycki

et al. 2018

JCM

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Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31–0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.

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“…In patients undergoing surgery with sphincter preservation, the three-year disease-free survival rate was higher for patients treated with TaTME than for patients treated with LapTME. These bene ts could be explained by an improved quality of the mesorectal specimen, with fewer positive resection margins, and lower rate of rectal perforations (4,22,23).…”

Section: Discussionmentioning

confidence: 99%

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis

Lacy

Roodbeen²,

Ríos

et al. 2020

Preprint

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Background For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Methods Consecutive patients with rectal cancer within 12 centimetres from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. Results A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At three years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1–6.1) in the TaTME group and 9.6% (95% CI, 6.5–12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23–0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8–79.8) and 68.6% (95% CI, 63.7–73.5) (HR = 0.82; 95% CI, 0.65–1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7–91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53–1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62–0.98; p = 0.033). Conclusions These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.

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Association of Plane of Total Mesorectal Excision With Prognosis of Rectal Cancer

Abstract: ClinicalTrials.gov Identifier: NCT00349076.

Cited by 82 publications

References 42 publications

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis

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