Transanal Total Mesorectal Excision (TaTME) versus Laparoscopic Total Mesorectal Excision for Lower Rectal Cancer: A Propensity Score-Matched Analysis

Abstract

Studies have reported positive short-term and histopathological results of transanal total mesorectal excision (TaTME) for mid-low rectal cancer. The long-term oncological outcomes are diverse, and concerns regarding the high local recurrence (LR) rate of TaTME have recently increased. We retrospectively analyzed 298 consecutive patients who underwent Laparoscopic TME (LapTME) or TaTME between January 2015 and December 2019. Propensity score-matching (PSM) was performed with patients matched for demographics and stage. After PSM, 63 patients were included in each group. The TaTME group had a longer mean operative time (394 vs. 333 min, p < 0.001). The blood loss, diverting stoma rate, and conversion rate were similar. Postoperatively, TaTME and LapTME had compatible complications, recovery, and hospital stay. A similar specimen quality was detected in both groups. After a mean follow-up period of 41–47 months, TaTME had less LR than LapTME (9.5% vs. 23.8%, p = 0.031). The 3-year overall survival was 80.3% in the TaTME group and 73.6% in the LapTME group (p = 0.331). The 3-year disease-free survival (DFS) rate was 72.0% in the TaTME group and 56.6% in the LapTME group (p = 0.038). In conclusion, better DFS and fewer LR events were observed after TaTME; thus, TaTME can be considered a safe and feasible approach in patients with low rectal cancer.

Transanal total mesorectal excision (TaTME) in rectal cancer treatment within an expert center

“…In a study by Deijen et al 27 , the risk of local recurrence in patients who underwent TaTME was 4%. On the other hand, in a 2022 study by Lin et al 28 , local cancer recurrence was observed in 6 (9.5%) patients operated on for low rectal tumors using TaTME as compared to 15 (23.8%) patients operated on using the LaTME technique. As confirmed by these data, compared to the procedure carried out using abdominal access (LaTME), where complete excision of the mesorectum from the abdomen toward the pelvic floor is more difficult, particularly in patients with low rectal cancer, the TaTME technique, which uses transanal access, ensures better visibility of the mesorectum, facilitates preservation of adequate oncological margins, and thus reduces the risk of local cancer recurrence 27 – 29 .…”