Transanal total mesorectal excision for rectal cancer has been suspended in Norway

Abstract

Background: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. Results: In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7⋅6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2⋅4 years was 11⋅6 (95 per cent c.i. 6⋅6 to 19⋅9) per cent after TaTME compared with 2⋅4 (1⋅4 to 4⋅3) per cent in the NCCR (P < 0⋅001). The adjusted hazard ratio was 6⋅71 (95 per cent c.i. 2⋅94 to 15⋅32). Anastomotic leaks resulting in reoperation occurred in 8⋅4 per cent of patients in the TaTME cohort compared with 4⋅5 per cent in NoRGast (P = 0⋅047). Fifty-six patients (35⋅7 per cent) had a stoma at latest follow-up; 39 (24⋅8 per cent) were permanent.Conclusion: Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.

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

“…In centers where TaTME is routinely performed, short-and longterm results have been reported as non-inferior to those of laparoscopic TME, with advantages in terms of short-term outcomes, such as postoperative complications and readmission, and non-inferiority in terms of long-term oncological outcomes [8]. However, there have been some reports of specific surgical complications associated with TaTME (urethral injuries, pelvic wall injuries, carbon dioxide embolism, nerve damage) [9,10]. A more worrisome issue is the unexpectedly high rate of early locoregional recurrence reported in two studies analyzing oncological outcomes in the early phase of TaTME implementation [10,11].…”

“…However, there have been some reports of specific surgical complications associated with TaTME (urethral injuries, pelvic wall injuries, carbon dioxide embolism, nerve damage) [9,10]. A more worrisome issue is the unexpectedly high rate of early locoregional recurrence reported in two studies analyzing oncological outcomes in the early phase of TaTME implementation [10,11]. In light of these reports, the need for standardized surgical education and proper training in this technique have been advocated [12].…”

The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care

“…Based on these data, the Danish National Board of Health revised the directives for risk assessment and patient information with the aim to ensure correct case management. In Norway the Colorectal Cancer Registry was used to evaluate outcome after transanal total mesorectal excision for rectal cancer with identification of higher anastomotic leak rates and unfavorable local recurrence rates, which led to a national recommendation against this surgical technique [72]. In Sweden and in Norway, clinical registries have been used to verify low case volumes for e.g., penile cancer and sarcoma, which has supported treatment centralized to national expert centers [73].…”

Rektumkarzinom – Robotic Setup, Port Placement, strukturierte OP-Schritte

“…Die Methode ist allerdings sehr komplex, schwierig zu erlernen und erfordert sowohl ein intensives Trainingsprogramm als auch eine hohe Fallzahl, bevor sie sicher durchgeführt werden kann [7]. Darüber hinaus mehren sich kritische Stimmen in Hinblick auf potenzielle Komplikationen, wie frühzeitige Beckenrezidive und erhöhte Anastomoseninsuffizienzraten nach TaTME [8,9].…”