Transanal total mesorectal excision compared to laparoscopic TME for mid and low rectal cancer—current evidence

Oostendorp, S. E. van; Koedam, T. W. A.; Sietses, C.; Bonier, H. Jaap; Tuynman, Jurriaan B.

doi:10.21037/ales.2018.04.02

Cited by 13 publications

(19 citation statements)

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“…Postoperative complications according to Clavien-Dindo ≥ III occurred in 19.2%. These results suggest that the structured training pathway does result in safe introduction of the technique without major intraoperative complications and safe results comparable to those obtained from laparoscopic TME surgery [8,19]. Compared to the international TaTME registry, especially the intraoperative event rate seems low; the registry reports 30.6% intraoperative adverse events rate, of which a vast majority (18%) regarded technical problems leaving 12.6% to visceral injuries (1.8%) of which 12 urethral injuries (0.8%), incorrect dissection planes (5.7%), and pelvic haemorrhage (4.2%) [9].…”

Section: Discussionsupporting

confidence: 63%

“…However, evaluating a surgical learning curve needs higher number of cases (80) to allow a CUSUM analysis [12,[25][26][27]. Future studies will address learning curves within centers that have undergone a structured training curriculum [2,8,28,29]. In laparoscopic surgery, learning curve ranging from 100 to 150 cases as self-taught learning curve and 40-60 with proctoring/teaching programs is reported [25,[28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…Especially the conversion rate seems to benefit from TaTME compared to Lap TME (2% versus 12%) as shown in both registry and systematic reviews [8,9]. The circumferential resection margin (CRM) involvement after TaTME has shown to be slightly lower as observed in conventional or robotic TME in pooled analysis by weighted averages: 4.6% versus 7.9% versus 5.1%, respectively [8][9][10]. However, direct comparison in large trials has yet to confirm this difference and demonstrate oncological safety.…”

mentioning

confidence: 86%

“…Current evidence from non-randomized studies shows that the TaTME technique for mid and low rectal cancer has similar short-term clinical outcomes compared to laparoscopic TME (Lap TME) in terms of complications including anastomotic leakage, margin involvement, and specimen quality. Especially the conversion rate seems to benefit from TaTME compared to Lap TME (2% versus 12%) as shown in both registry and systematic reviews [8,9]. The circumferential resection margin (CRM) involvement after TaTME has shown to be slightly lower as observed in conventional or robotic TME in pooled analysis by weighted averages: 4.6% versus 7.9% versus 5.1%, respectively [8][9][10].…”

mentioning

confidence: 89%

“…cancer, and (male) patients with a narrow pelvis seem to benefit from this approach [5,6]. TaTME has been introduced in 2010 and has had enthusiastic uptake throughout the world [7,8]. Current evidence from non-randomized studies shows that the TaTME technique for mid and low rectal cancer has similar short-term clinical outcomes compared to laparoscopic TME (Lap TME) in terms of complications including anastomotic leakage, margin involvement, and specimen quality.…”

mentioning

confidence: 99%

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Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands

et al. 2019

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Background Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown to be associated with a relative long learning curve which might hamper widespread adoption. Therefore, a national structured training pathway for TaTME has been set up in the Netherlands to allow safe implementation. The aim of this study was to monitor safety and efficacy of the training program with 12 centers. Methods Short-term outcomes of the first ten TaTME procedures were evaluated in 12 participating centers in the Netherlands within the national structured training pathway. Consecutive patients operated during and after the proctoring program for rectal carcinoma with curative intent were included. Primary outcome was the incidence of intraoperative complications, secondary outcomes included postoperative complications and pathological outcomes. Results In October 2018, 12 hospitals completed the training program and from each center the first 10 patients were included for evaluation. Intraoperative complications occurred in 4.9% of the cases. The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5.0% of patients. Overall postoperative complication rate was 45.0%, with 19.2% Clavien-Dindo ≥ III and an anastomotic leak rate of 17.3%. Conclusions This study shows that the nationwide structured training program for TaTME delivers safe implementation of TaTME in terms of intraoperative and pathology outcomes within the first ten consecutive cases in each center. However, postoperative morbidity is substantial even within a structured training pathway and surgeons should be aware of the learning curve of this new technique.Keywords TaTME · TAMIS · Rectal cancer · Proctoring · Training Transanal total mesorectal excision (TaTME) has been proposed as a potentially better alternative to the laparoscopic standard TME for mid and distal rectal cancer [1][2][3][4]. The bottom-up approach for the deep pelvic region increases exposure and facilitates the distal mesorectal excision. Especially those difficult cases such as obese patients, low rectal and Other Interventional Techniques Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 86%

mentioning

confidence: 89%

mentioning

confidence: 99%

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Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands

et al. 2019

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Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer

et al. 2021

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IMPORTANCE Proponents of novel transanal total mesorectal excision (TME) suggest the procedure overcomes the technical and oncologic challenges of conventional approaches for treating rectal cancer. Recently, however, there has been controversy regarding the oncologic safety of the procedure. OBJECTIVE To assess the association of transanal TME with the incidence of local recurrence (LR) of cancer and the probability of remaining free of LR during follow-up. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from 8 highvolume rectal cancer academic institutions from across Canada on all consecutive patients with primary rectal cancer treated by transanal TME at the participating centers. The study was conducted

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Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation

Oostendorp

Belgers

Bootsma

et al. 2020

British Journal of Surgery

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Background: Transanal total mesorectal excision (TaTME) has been proposed as an approach in patients with mid and low rectal cancer. The TaTME procedure has been introduced in the Netherlands in a structured training pathway, including proctoring. This study evaluated the local recurrence rate during the implementation phase of TaTME. Methods: Oncological outcomes of the first ten TaTME procedures in each of 12 participating centres were collected as part of an external audit of procedure implementation. Data collected from a cohort of patients treated over a prolonged period in four centres were also collected to analyse learning curve effects. The primary outcome was the presence of locoregional recurrence. Results: The implementation cohort of 120 patients had a median follow up of 21⋅9 months. Short-term outcomes included a positive circumferential resection margin rate of 5⋅0 per cent and anastomotic leakage rate of 17 per cent. The overall local recurrence rate in the implementation cohort was 10⋅0 per cent (12 of 120), with a mean(s.d.) interval to recurrence of 15⋅2(7⋅0) months. Multifocal local recurrence was present in eight of 12 patients. In the prolonged cohort (266 patients), the overall recurrence rate was 5⋅6 per cent (4⋅0 per cent after excluding the first 10 procedures at each centre). Conclusion: TaTME was associated with a multifocal local recurrence rate that may be related to suboptimal execution rather than the technique itself. Prolonged proctoring, optimization of the technique to avoid spillage, and quality control is recommended.

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Transanal total mesorectal excision compared to laparoscopic TME for mid and low rectal cancer—current evidence

Cited by 13 publications

References 50 publications

Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands

Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands

Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer

Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation

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