Transanal Total Mesorectal Excision for Malignant Rectal Lesion: A Prospective Cohort Study

Abstract

AIMS: The main outcome of this study was to use the transanal total mesorectal excision (TaTME) technique for rectal cancer resection and to assess as a primary endpoint the short-term oncological outcome; in terms of circumferential resection margin, longitudinal resection margins (proximally and distally), and lymph nodes (LN) retrieval, while secondary endpoints were operative time, estimated blood loss, length of hospital stay, cost per case, and overall complication rate. METHODS: This was a prospective cohort study. Forty patients were included and subjected to TaTME from May 2018 to January 2020 and patients were followed up for a period of 6 months. RESULTS: Primary endpoint: Depending on the post-operative specimen pathological assessment; circumferential resection margin (CRM) was free in all patients, proximal resection margins had a mean 14.37 2.87 cm, distal resection margins had a mean 2.08 ± 0.4 cm and LNs retrieval had a mean 13.27 ± 5.9, and number of positive LNs had a mean 2.40 ± 3.77. Secondary endpoints: Mean total operative time (from induction of anesthesia till skin closure) was 179.10, estimated blood loss (using gauze visual analog plus what was obtained in the OR suction device) was 133.67 66.59 ml, the length of hospital stay (admission till discharge) was 5.27 ± 1.08 days, cost per case had a mean (in 1000 USD) 2.95 ± 0.12, and overall complication rate was 10%. CONCLUSION: TaTME represents a promising complementary technique to laparoscopic TME in the step of low rectal dissection.

Economic analysis of open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: A systematic review

“…Four studies reported costs of one technique [25,28,31,32]. These studies included a total of 59 L-TME, 104 R-TME, 40 TaTME patients.…”

“…This study reported total costs of $11,166.91. One study (Elbarmelgi et al) [32] reported costs of TaTME. This study reported total costs of $2,788.90.…”

“…Following title and abstract screening, 93 studies were selected for full-text evaluation. Ultimately, 12 studies met the predetermined search criteria and were selected for qualitative synthesis [10,[22][23][24][25][26][27][28][29][30][31][32]. A meta-analysis was not performed, due to heterogeneity resulting from differences in the learning curve of the performing surgeon and heterogeneity among the included cost components.…”

“…No studies comparing R-TME with TaTME, or open TME with R-TME were included in this review. Additionally, four studies only reported costs of a single technique [25,28,31,32]. A total of 2542 rectal cancer patients were included, 1192 (46.9%) of whom underwent L-TME, 998 (39.3%) R-TME, 226 (8.9%) open TME and 126 (5.0%) TaTME.…”