Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision

Abstract

Background Aim of this study was to evaluate functional outcomes of transanal total mesorectal excision (TaTME) in comparison to conventional laparoscopic approach (LaTME) in terms of low anterior resection syndrome (LARS). Methods Forty-six patients who underwent total mesorectal excision for low rectal cancer between 2013 and 2017 were enrolled. Primary outcome was the severity of faecal incontinence, assessed both before the treatment and 6 months after ileostomy reversal. LARS score and Jorge-Wexner scale were utilized to analyze its severity. Results Twenty (87%) from TaTME and 21 (91%) from LaTME group developed LARS postoperatively. There were no significant differences between groups in terms of LARS occurrence ( p = 0.63) and severity. The median Wexner score was comparable in both groups (8 [IQR: 4–12] vs 7 [3–11], p = 0.83). Univariate analysis revealed that postoperative complications were a risk factor for LARS development ( p = 0.02). Perioperative outcomes, including operative time, blood loss and intraoperative adverse events did not differ significantly between groups either. Five TaTME patients developed postoperative complications, while there were morbidity 6 cases in LaTME group. Quality of mesorectal excision was comparable with 20 and 19 complete cases in TaTME and LaTME groups, respectively. Conclusions TaTME provided comparable outcomes in terms of functional outcomes in comparison to LaTME for total mesorectal excision in low rectal cancers. Having said that, LARS prevalence is still high and requires further evaluation of the technique.

Investigating Risk Factors for Complications after Ileostomy Reversal in Low Anterior Rectal Resection Patients: An Observational Study

“…We explored this topic in our previous research, which revealed that defunctioning ileostomy was a risk factor of low anterior resection syndrome (LARS) in patients undergoing low anterior rectal resection [21]. Moreover, the prevalence of LARS syndrome in the abovementioned is still high and requires further investigation to limit its occurrence [36].…”

Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: a ‘New Health Technology’ assessment in South Korea

“…Finally, 16 cohort studies met all the inclusion criteria and none of the exclusion criteria ( Fig. 1 ) [ 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ]. Seven of the cohort studies were case-matched studies comparing TaTME with LaTME for rectal cancer [ 25 28 29 30 31 36 38 ].…”

“…Perdawood et al [ 35 ] and Fernández-Hevia et al [ 24 ] reported a 2-team approach as standard; Alamili et al [ 32 ], Chen et al [ 34 ], Roodbeen et al [ 36 ], Sparreboom et al [ 38 ], Chang and Kiu [ 28 ], and Mege et al [ 30 ] used a 1-team approach. Persiani et al [ 31 ], Lelong et al [ 37 ], Chen et al [ 25 ], and Rasulov et al [ 26 ] used both a 1- and 2-team approach. There was a notable heterogeneity between included studies (I 2 = 88%, P < 0.001).…”

Short‐term outcomes of medium‐low rectal cancer treated by taTME and experience of 22 cases

“…Thus, taTME is seen as a “down‐to‐up” novel approach in the surgical field. Nonetheless, it involves extensive dissection of pelvic structures and affects the function of anal sphincters 8 9,10 .…”

“…Nonetheless, it involves extensive dissection of pelvic structures and affects the function of anal sphincters. 8 Due to the steep learning curve and difficulty of the operation, the procedure also results in a relatively high incidence of severe complications such as urethral, blood vessel, and nerve injury, as well as anastomotic leakage. 9,10 So studies with large sample sizes and a multicentric prospective design are needed to verify the oncological and functional outcomes of taTME.…”