Local Recurrence After Transanal Total Mesorectal Excision for Rectal Cancer

Abstract

Objective: This study aimed to determine local recurrence (LR) rate and pattern after transanal total mesorectal excision (TaTME) for rectal cancer. Background: TaTME for mid-and low rectal cancer has known a rapid and worldwide adoption. Recently, concerns have been raised on the oncological safety in light of reported high LR rates with a multifocal pattern. Methods: This was a multicenter observational cohort study in 6 tertiary referral centers. All consecutive TaTME cases for primary rectal adenocarcinoma from the first TaTME case in every center until December 2018 were included for analysis. Patients with benign tumors, malignancies other than adenocarcinoma and recurrent rectal cancer, as well as exenterative procedures, were excluded. The primary endpoint was 2-year LR rate. Secondary endpoints included patterns and treatment of LR and histopathological characteristics of the primary surgery. Results: A total of 767 patients were identified and eligible for analysis. Resection margins were involved in 8% and optimal pathological outcome (clear margins, (nearly) complete specimen, no perforation) was achieved in 86% of patients. After a median follow-up of 25.5 months, 24 patients developed LR, with an actuarial cumulative 2-year LR rate of 3% (95% CI 2-5). In none of the patients, a multifocal pattern of LR was observed. Thirteen patients had isolated LR (without systemic disease) and 10/13 could be managed by salvage surgery of whom 8 were disease-free at the end of follow-up. Conclusions and Relevance: This study shows good loco regional control after TaTME in selected cases from tertiary referral centers and does not indicate an inherent oncological risk of the surgical technique.

The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience

“…Third, the oncological outcomes of this study, albeit limited to less than half of the patients with adequate follow-up data, confirm that TaTME is a safe procedure for the treatment of rectal cancer in terms of the pathological results and recurrence rate. These results are in line with those recently published in a large multicenter study on TaTME and the local recurrence rate after TaTME, which are in net contrast with the data from the Norwegian experience [29].…”

“…Finally, the pathological and oncological results in terms of local recurrence in this case series are promising and consistent with those available from expert centers [9,29], which provides reassurance that the technique is oncologically adequate and safe.…”

Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer

“…Transanal total mesorectal excision (TaTME) was introduced for mid and lower rectal cancer and is proposed to allow a precise mesorectal dissection through better visualization in anatomically limited pelvis (male, narrow, obese). The “bottom-up” approach has been proposed to improve TME quality (88.5% complete TME) with low local recurrence rates in specialized centers in the mid-term follow-up [ 10 , 11 , 12 , 13 , 14 ].…”

“…Recently, however, several high-volume centers as well as international registry data contradicted the Norwegian experience, highlighting the importance of a structured training for safe implementation and indication of this challenging new technique [ 10 , 16 ].…”

Rectal eversion for direct access to the distal resection margin: do we need another tool in the toolbox of rectal cancer surgery?

“…Rectal cancer below the peritoneal reflection is currently one of the most challenging diseases in colorectal surgery. Advances in contemporary imaging, complexities of multimodality approaches and a variety of surgical and even non-surgical alternatives have all led to improvements in local disease control, sphincter and organ preservation and more recently, even in survival [1][2][3][4][5][6]. Colorectal surgeons in particular, now have plenty of tools to choose from to provide the pathologist with the perfect total mesorectal excision (TME) specimen and patients with an optimal outcome.…”