Should transanal total mesorectal excision be implemented in medium-sized colorectal unit? technical and oncological outcome

Abstract

This study was performed to evaluate the outcome of implementation of transanal total mesorectal excision (TaTME) for low rectal cancer in a regional hospital and in comparison to laparoscopic (Lap) TME. Methods: Consecutive patients with low rectal cancer of which the lowest border of the tumour was located beween 1 and 5 cm from the puborectalis who underwent TME at North District Hospital between January 2013 and December 2019 were included. Clinical, operative, and pathologic outcomes were compared between Lap TME and TaTME. The primary end point was complication profile. Results: Thirty-five patients underwent Lap TME and 45 patients underwent TaTME for low rectal cancer. The conversion rate of the TaTME group was significantly lower than that of the Lap TME group (4.4% vs. 20%, P = 0.029), but the operating time was longer (259 minutes vs. 219 minutes, P = 0.009). The tumour location was significantly lower in the TaTME group, but the distal resection margins were adequate and not different between both groups. The TaTME group had higher incidence rates of prolonged ileus and urinary tract infection, but the other complications were similar between the two groups. The resection margin positivity rates of the TaTME and Lap TME groups were 2.2% and 5.7%, respectively (P = 0.670). At a median follow up of 39 months, no abnormal early recurrence was detected. Conclusion: It is technically feasible and oncologically safe to perform TaTME in a medium-volume colorectal unit. Patients with difficult pelvic anatomy can benefit by reducing the risk of conversion and margin positivity rate.

Transanal total mesorectal excision for rectal cancer: it’s come a long way and here to stay

“…The desirable prerequisites for a trainer for TaTME were at least 30 cases performed independently, provision of training courses with possible cadaveric resources and an academic output of at least 2 papers a year. This was validated in a recent paper by Ho et al [ 37 ], where they reported safe perioperative and oncological outcomes in their medium-sized colorectal unit of around 30 rectal cancer resections a year.…”

“…The desirable prerequisites for a trainer for TaTME were at least 30 cases performed independently, provision of training courses with possible cadaveric resources and an academic output of at least 2 papers a year. This was validated in a recent paper by Ho et al [37], where they reported safe perioperative and oncological outcomes in their medium-sized colorectal unit of around 30 rectal cancer resections a year. Perhaps the most important is direct clinical proctorship with regular evaluation of pathological quality of resected TME specimens and analysis of clinical outcome data including complications, mortality, and oncological results.…”

Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes

“…There are studies on various approaches for organ preserving surgery. Representative surgical method is the trans-anal approach, which is to perform TME by approaching through the anus [ 92 93 98 99 ]. There are several studies showing that oncologic safe is obtained, and functional outcome is not inferior to laparoscopy [ 98 100 ].…”

Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach

“…There has been steady progress in the field of minimally invasive surgical treatments for colorectal cancer over the past decade [1][2][3][4][5][6][7][8]. Laparoscopic surgery has revolutionized the field of colorectal cancer treatment, gaining widespread acceptance and becoming a routine choice for many patients due to its feasibility and proven oncologic safety in numerous studies [1][2][3]5,7].…”