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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2021

01-02-2021 | Rectal Cancer

Transanal total mesorectal excision: the Slagelse experience 2013–2019

Authors: Sharaf Karim Perdawood, Jens Kroeigaard, Marianne Eriksen, Pauli Mortensen

Published in: Surgical Endoscopy | Issue 2/2021

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Abstract

Objective

To describe outcomes after transanal total mesorectal excision (TaTME) 5 years from implementation at a large-volume colorectal unit, including local recurrence, distant metastasis, and survival.

Background

Transanal total mesorectal excision (TaTME) is a relatively new procedure for mid- and low-rectal cancer, with well-documented safety and feasibility. However, data on long-term results are limited.

Methods

This study was based on a prospective data collection via a maintained database in a large colorectal unit. The database included patients who underwent TaTME from December 2013 through July 2019. We have updated the database through a review of patient charts, including radiology and pathology reports. Data collection included operative details, intraoperative findings, postoperative complications, pathologic results, and oncologic results.

Results

During the study period, two hundred patients underwent TaTME in the study period (men = 147). The mean BMI was 26.7%, and the mean tumor height from the anal verge was 7.86 cm. Neoadjuvant treatment was given to 22% of patients. Anastomotic leakage occurred in 9.3% of patients, and the overall rate of postoperative complications was 24.5%. The TME specimen was incomplete in 11% of patients, and the CRM was positive in 5.5% of patients. Local recurrence (LR) occurred in seven patients with a follow-up of at least 2 years (4.7%). Distant metastasis (DM) occurred in 12% of patients. The overall survival was 90% and disease-free survival was 81%. The operating time was reduced in the later period of our experience.

Conclusions

This study showed that TaTME is feasible, safe, and had acceptable short-term outcomes and an acceptable rate of LR. The study included, however, one group that was non-randomized, and the follow-up was not long enough for most patients. Studies with longer follow-up data are awaited.
Literature
1.
Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17(3):257–258PubMed
2.
Perdawood, S.K. and G.A. Al Khefagie, Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis, 2016. 18(1):51–58.
3.
Perdawood SK, Thinggaard BS, Bjoern MX (2018) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc 32(5):2312–2321PubMed
4.
Perdawood SK et al (2019) The pattern of defects in mesorectal specimens: is there a difference between transanal and laparoscopic approaches? Scand J Surg 108(1):49–54PubMed
5.
Bjoern MX, Nielsen S, Perdawood SK (2019) Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg 23(8):1623–1630PubMed
6.
Knol JJ et al (2015) Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below—a preliminary report. Tech Coloproctol 19(4):221–229PubMed
7.
Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19(2):57–61PubMed
8.
Atallah S (2014) Transanal minimally invasive surgery for total mesorectal excision. Minim Invasive Ther Allied Technol 23(1):10–16PubMed
9.
10.
Quirke, P., et al., Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet, 1986. 2(8514):996–999.
11.
Quirke P et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828PubMedPubMedCentral
12.
Nagtegaal ID et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729–1734PubMed
13.
Fleshman J et al (2015) Effect of laparoscopic-assisted resection vs. open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355PubMedPubMedCentral
14.
Clavien PA et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196PubMed
15.
Nerup N et al (2013) Promising results after endoscopic vacuum treatment of anastomotic leakage following resection of rectal cancer with ileostomy. Dan Med J 60(4):A4604PubMed
16.
Penna M et al (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266(1):111–117PubMed
17.
Adamina M et al (2018) St.Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 32(3):1091–1103PubMed
18.
Rouanet P et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56(4):408–415PubMed
19.
Dickson EA et al (2019) Carbon dioxide embolism associated with transanal total mesorectal excision surgery: a report from the international registries. Dis Colon Rectum 62(7):794–801PubMed
20.
Bulow S et al (2011) Intra-operative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Colorectal Dis 13(11):1256–1264PubMed
21.
Bjorn MX, Perdawood SK (2015) Transanal total mesorectal excision—a systematic review. Dan Med J 62(7):5105
22.
Penna M et al (2019) Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the International TaTME Registry. Ann Surg 269(4):700–711PubMed
23.
Ma B et al (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380PubMedPubMedCentral
24.
Stevenson AR et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT Randomized Clinical Trial. JAMA 314(13):1356–1363PubMed
25.
Perdawood SK (2018) A case of local recurrence following transanal total mesorectal excision: a new form of port-site metastasis? Tech Coloproctol 22(4):319–320PubMed
26.
Heald RJ (1979) A new approach to rectal cancer. Br J Hosp Med 22(3):277–281PubMed
27.
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69(10):613–616PubMed
28.
Heald RJ et al (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899PubMed
29.
Bonjer HJ et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 373(2):194PubMed
30.
Jeong SY et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774PubMed
31.
Kang SB et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645PubMed
32.
Fleshman J (2016) Current status of minimally invasive surgery for rectal cancer. J Gastrointest Surg 20(5):1056–1064PubMed
33.
Fleshman J et al (2019) Disease-free Survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269(4):589–595PubMed
34.
Bonjer HJ et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332PubMed
35.
Nagtegaal ID et al (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23(36):9257–9264PubMed
36.
Jayne D et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580PubMedPubMedCentral
37.
Funahashi K et al (2009) Transanal rectal dissection: a procedure to assist achievement of laparoscopic total mesorectal excision for bulky tumor in the narrow pelvis. Am J Surg 197(4):e46–50PubMed
38.
Denost Q et al (2014) Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg 260(6):993–999PubMed
39.
Denost Q et al (2018) Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux' randomized trial. Surg Endosc 32(3):1486–1494PubMed
40.
Buess G et al (1992) Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163(1):63–69PubMed
41.
Whiteford MH, Denk PM, Swanstrom LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21(10):1870–1874PubMed
42.
Telem DA et al (2013) Transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series. Surg Endosc 27(1):74–80PubMed
43.
de Lacy FB et al (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32(5):2442–2447PubMed
44.
Simillis C et al (2016) A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18(1):19–36PubMed
45.
Larsen SG et al (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg 106(9):1120–1121PubMed
46.
Hol JC et al (2019) Long-term oncological results after transanal total mesorectal excision for rectal carcinoma. Tech Coloproctol 23:903–911PubMedPubMedCentral
47.
48.
Atallah S, Sylla P, Wexner SD (2019) Norway versus the Netherlands: will taTME stand the test of time? Tech Coloproctol 23(9):803–806PubMed
Metadata
Title
Transanal total mesorectal excision: the Slagelse experience 2013–2019
Authors
Sharaf Karim Perdawood
Jens Kroeigaard
Marianne Eriksen
Pauli Mortensen
Publication date
01-02-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07454-2

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