Outcomes of completion total mesorectal excision are not compromised by prior transanal minimally invasive surgery

Abstract

Aim Transanal minimally invasive surgery (TAMIS) is used increasingly often as an organ‐preserving treatment for early rectal cancer. If final pathology reveals unfavourable histological prognostic features, completion total mesorectal excision (cTME) is recommended. This study is the first to investigate the results of cTME after TAMIS. Method Data were retrieved from the prospective database of the Elisabeth‐TweeSteden Hospital. Completion TME patients were case matched with a control group of patients undergoing primary TME (pTME). Primary and secondary outcomes were surgical outcomes and oncological outcomes, respectively. Results From 2011 to 2017, 20 patients underwent cTME and were compared with 40 patients undergoing pTME. There were no significant differences in operating time (238 min vs 226 min, P = 0.53), blood loss (137 ml vs . 158 ml, P = 0.88) or complications (45% vs 55%, P = 0.07) between both groups. There was no 90‐day mortality in the cTME group. The mesorectal fascia was incomplete in three patients (15%) in the cTME group compared with no breaches in the pTME group ( P = 0.083). There were no local recurrences in either group. In three patients (15%), distant metastases were detected after cTME compared with one patient (2.5%) in the pTME group ( P = 0.069). After cTME patients had a 1‐ and 5‐year disease‐free survival of 85% compared with 97.5% for the pTME group ( P = 0.062). Conclusion Completion TME surgery after TAMIS is not associated with increased peri‐ or postoperative morbidity or mortality compared with pTME surgery. After cTME surgery patients have a similar disease‐free and overall survival when compared with patients undergoing pTME.

Implementation of transanal minimally invasive surgery (TAMIS) for rectal neoplasms: results from a single centre

“…Although only 9 patients had cTME and the observation time is short, the study supports the findings in other studies that cTME is feasible after local excisions of early rectal cancer, and the long-term oncological results seem good as we had no recurrences, local or distant, in this group [5,22].…”

Completion Total Mesorectal Excision After Transanal Local Excision of Early Rectal Cancer: A Systematic Review and Meta-analysis

“…This cohort of patients has unfavorable histopathological characteristics, including R1 TAE resections, and some are likely to have residual cancer or involved LNs at the time of cTME. Seventeen studies 8,10,11,30,31,33–40,42–45 report this outcome. The weighted average rate of residual disease is 35% for 423 patients (range, 0%–80%).…”

“…Within the meta-analyses presented in this review, 4 studies included patients who have undergone a form of neoadjuvant chemoradiation. 11,30,46,47 Clermonts et al and Piessen et al detailed case matching of controls by chemoradiation status. Morino et al and van Gijn et al included patients who had undergone NACR but had not explicitly stated NACR as a case-matched factor.…”

“…This cohort of patients has unfavorable histopathological characteristics, including R1 TAE resections, and some are likely to have residual cancer or involved LNs at the time of cTME. Seventeen studies 8,10,11,30,31,[33][34][35][36][37][38][39][40][42][43][44][45]…”

Nomograms and risk score models for predicting survival in rectal cancer patients with neoadjuvant therapy

“…The P values of operation time, cT and ypTNM were higher than 0.05. The distance of the tumor from the anal margin is closely related to operation time and other important factors[ 19 - 21 ] because if the tumor is close to the anus, anal preservation will be prioritized. However, removing the anus or preserving the lower anus can be a lengthy procedure; therefore, the operation time may be related to the tumor location after NT.…”