Is trans‐anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case‐matched study in 68 patients

Mège, Diane; Hain, Élisabeth; Lakkis, Zaher; Maggiori, Léon; Denise, J. Prost à la; Panis, Yves

doi:10.1111/codi.14238

Cited by 45 publications

(69 citation statements)

References 31 publications

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“…One thousand two hundred and forty-seven citations were retrieved from the search strategy. Finally, twelve studies [24][25][26][27][28][29][30][31][32][33][34][35] were included in the analysis, with a total of 899 patients (411 patients in TaTME group, 488 patients in LaTME group) ( Figure 1). The characteristics of eligible studies are shown in Table I.…”

Section: Resultsmentioning

confidence: 99%

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Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Lin

Chen

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: The benefit of transanal total mesorectal excision (TaTME) for mid and low rectal cancer is conflicting. Aim: To assess and compare the short-term outcomes of TaTME with conventional laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer. Material and methods: We searched PubMed, Embase and Cochrane Library databases for studies addressing TaTME versus conventional LaTME for rectal cancer between 2008 and December 2018. Randomized controlled trials (RCTs) and retrospective studies which compared TaTME with LaTME were included. Results: Twelve retrospective case-control studies were identified, including a total of 899 patients. We did not find significant differences in overall intraoperative complications, blood loss, conversion rate, operative time, overall postoperative complication, anastomotic leakage, ileus, or urinary morbidity. Also no significant differences in oncological outcomes including circumferential resection margin (CRM), positive CRM, distal margin distance (DRM), positive DRM, quality of mesorectum, number of harvested lymph nodes, temporary stoma or local recurrence were found. Although the TaTME group had better postoperative outcomes (readmission, reoperation, length of hospital stay) on average, the difference did not reach statistical significance. Conclusions: Transanal total mesorectal excision offers a safe and feasible alternative to LaTME although the clinicopathological features were not superior to LaTME in this study. Currently, with the lack of evidence on benefits of TaTME, further evaluation of TaTME requires large randomized control trials to be conducted.

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Section: Resultsmentioning

confidence: 99%

“…There were six studies [24-27, 31, 34] that reported CRM, eleven studies [24][25][26][28][29][30][31][32][33][34][35] that reported positive CRM, eight studies [24-27, 30, 32-34] that reported DRM and five studies [25,28,31,34,35] that reported positive DRM. No differences were found in these pathological outcomes ( Figure 5).…”

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confidence: 99%

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Lin

Chen

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…Nevertheless, due to its complexity, the usage of different minimally invasive techniques in taTME is associated with a significant rate of intraoperative rectal, vaginal, or bladder injury during the learning curve, mainly due to the anatomical landmarks which are different from those during standard laTME from above. However, beyond the learning curve, the rate of intraoperative complications decreases [26,27,28]. Postoperative outcomes and oncological results of taTME and laTME were reported by several retrospective and comparative studies to be similar.…”

Section: Discussionmentioning

confidence: 99%

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

et al. 2019

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Background: The novel surgical procedure transanal total mesorectal excision (taTME) has rapidly become an interest of research in order to overcome the shortcomings of laparoscopic surgery in the treatment of middle and low rectal cancer. taTME is a new natural orifice transluminal endoscopic surgery modality combining three rectal surgery techniques. Methods: A retrospective clinical study was conducted in a single centre for a period of 3 years, and herein we report on our first 25 taTME procedures in patients with middle and lower third rectal adenocarcinoma. Results: The main demographics were evaluated. The mean age of patients was 64 ± 12 years. There were predominantly males (72%) and 7 female patients (28%) with an average body mass index of 29 ± 4.8 kg/m². High blood pressure, obesity, chronic heart insufficiency, chronic atrial fibrillation, and diabetes mellitus were commonly diagnosed in all patients. A circumferential resection margin >1 mm was achieved in 16% (n = 4), >2 mm in 40% (n = 10), and >3 mm in 44% (n = 11) of operated patients. The average CRM was 1.8 ± 0.9 cm. In 24% of cases, the distance of a tumour from the mesorectal fascia (MRF) was <1 mm; meanwhile, for 76% of patients, the tumour margin was >1 mm from the MRF. Recovery to flatus was 3 ± 1 days. The average length of hospital stay was 11 ± 3 days. The overall postoperative morbidity was 8%, i.e. one (4%) complication classified as Clavien-Dindo degree I and one (4%) major (IIIb) complication. Subsequently, all patients successfully recovered and were discharged from hospital. During the follow-up period no cancer recurrence was observed. Conclusion: Our results nicely demonstrate that taTME can be safely performed with acceptable perioperative complications in patients with middle or lower third rectal cancer. In addition, the perioperative morbidity is also acceptable. However, taTME remains a technically highly demanding operation but is feasible and safe after the appropriate experience is gained. Nevertheless, larger multi-centre prospective randomised studies are ongoing to confirm the safety and to verify oncological results when compared to laparoscopic rectal surgery.

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“…Although the learning curve of taTME has not been fully clarified 7,49) , the skills are believed to be difficult to acquire and care should be taken to avoid serious complications, especially in the early learning stages 50) . Deijen et al in their study performed pooled-analysis and compared clinical outcomes between low-volume (< 30 cases) and high-volume ("30 cases) centers.…”

Section: Education and Trainingmentioning

confidence: 99%

Transanal TME: new standard or fad?

Hasegawa

Yoshida

Morimoto

et al. 2019

J Anus Rectum Colon

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Transanal total mesorectal excision (taTME) has been developed to overcome the difficulty of laparoscopic dissection and transection in the deep pelvis. TaTME has several clinical benefits over laparoscopic surgery, such as better exposure of the distal rectum and direct determination of distal resection margin. Although evidence demonstrating the true benefits of taTME over laparoscopic TME (LapTME) is still insufficient, accumulating data have revealed that, as compared with LapTME, taTME is associated with shorter operative time and a lower conversion rate without jeopardizing other short-term outcomes. However, taTME is a technically demanding procedure with specific complications such as urethral injury, and so sufficient experience of LapTME and step-by-step acquisition of the skills needed for this procedure are requisite. The role of transanal endoscopic surgery is expected to change, along with the recent progress in the treatment of rectal cancer, such as robotic surgery and the watch-and-wait strategy. Optimization of treatment will be needed in the future in terms not only of oncological but also of functional outcomes.

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Is trans‐anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case‐matched study in 68 patients

Cited by 45 publications

References 31 publications

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

Transanal TME: new standard or fad?

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