Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes

Abstract

Background While a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI. Methods From June 2013, all consecutive TaTME cases were included and compared to lapTME in a single institution. Propensity score-matching was performed for nine relevant factors. Primary outcome was resection margin involvement (R1), secondary outcomes included intra- and post-operative outcomes. Results After matching, forty-one patients were included in each group; no significant differences were observed in patient and tumor characteristics. The resection margin was involved in 5 cases (12.2%) in the laparoscopic group, versus 2 (4.9%) TaTME cases ( P = 0.432). The TME specimen quality was complete in 84.0% of the laparoscopic cases and in 92.7% of the TaTME cases ( P = 0.266). Median distance to the circumferential resection margin (CRM) was 5 mm in lapTME and 10 mm in TaTME ( P = 0.065). Significantly more conversions took place in the laparoscopic group, 9 (22.0%) compared to none in the TaTME group ( P < 0.001). Other clinical outcomes did not show any significant differences between the two groups. Conclusion This is the first study to compare results of TaTME with lapTME in a highly selected patient group with MRI-defined low rectal tumors. A significant decrease in R1 rate could not be demonstrated, although conversion rate was significantly lower in this TaTME cohort.

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

“…In the international literature, a wide range of categories are used for rectal cancer volume at hospital level. Van Gijn et al calculated median cut-off points from published rectal cancer hospital volume studies, leading to a definition of a high-volume hospital a performing more than 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) rectal cancer resections per year and low-volume hospitals performing 9 (6-14) [28]. This hampers interpretation of the available literature on this topic.…”

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes.

“…One thousand two hundred and forty-seven citations were retrieved from the search strategy. Finally, twelve studies [24][25][26][27][28][29][30][31][32][33][34][35] were included in the analysis, with a total of 899 patients (411 patients in TaTME group, 488 patients in LaTME group) ( Figure 1). The characteristics of eligible studies are shown in Table I.…”

“…There were six studies [24-27, 31, 34] that reported CRM, eleven studies [24][25][26][28][29][30][31][32][33][34][35] that reported positive CRM, eight studies [24-27, 30, 32-34] that reported DRM and five studies [25,28,31,34,35] that reported positive DRM. No differences were found in these pathological outcomes ( Figure 5).…”

Robotic total mesorectal excision: state of the art

“…Several studies reported that Ta-TME achieved similar technical success and perioperative outcomes than laparoscopic TME, with a lower conversion rate [90] . Recent studies also showed that serious complications secondary to wrong down-to-up dissection planes were not despicable, same for anastomotic leaks [91] . To improve the accuracy of the transanal dissection, robotic technology could also be helpful [92] .…”