Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 7/2016

01-07-2016 | Original Article

Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer

Authors: J. H. Marks, G. A. Montenegro, J. F. Salem, M. V. Shields, G. J. Marks

Published in: Techniques in Coloproctology | Issue 7/2016

Login to get access

Abstract

Background

Natural orifice translumenal endoscopic surgery (NOTES) has always made more sense in the colorectal field where the target organ for entry houses the pathology. To address the question whether an adequate total mesorectal excision (TME) for rectal cancer can be performed from a transanal bottoms-up approach, we performed a case-matched study.

Methods

Starting in 2009, transanal TME (taTME) surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database. Between March 2012 and February 2014, 17 consecutive taTME rectal cancer patients were identified and case-matched to multiport laparoscopic TME (MP TME) based on age, body mass index, uT stage, radiation dose, level in the rectum, and procedure. Perioperative outcomes, morbidity, mortality, local recurrence, completeness of TME, and radial and distal margins were analyzed. Statistically significant differences were identified using Student’s t test.

Results

There were 12 transanal abdominal transanal (TATA)/5 abdominoperineal resection procedures in each group. Data regarding overall/taTME/MP TME are as follows: % positive-circumferential margin: 2.9/0/5.9 % (p = 0.32). Distal margin: 0/0/0 %. Complete or near-complete TME: 97.1/100/94.1 % (p = 0.32). Incomplete TME 2.9/0/5.9 % (p = 0.32). Local recurrence: 2.9/5.9/0 % (p = 0.32). There were no perioperative mortalities. Morbidity in each group: 26.4/23.5/29.4 % (p = 0.79). There were no differences in perioperative or postoperative outcomes except days to clear liquids (1/2 days, p = 0.03) and largest incision length (1.3/2.6 cm, p = 0.05).

Conclusions

We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottoms-up TME compared to standard laparoscopic TME. TaTME is a promising progressive approach to NOTES and deserves additional evaluation.
Literature
1.
Marwan K, Staples MP, Thursfield V, Bell SW (2010) The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 53:1645–1651CrossRefPubMed
2.
Enríquez-Navascués JM, Borda N, Lizerazu A et al (2011) Patterns of local recurrence in rectal cancer after a multidisciplinary approach. World J Gastroenterol 17:1674–1684CrossRefPubMedPubMedCentral
3.
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 327:1479–1482CrossRef
4.
5.
Quirke P, Steele R, Monson J 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 373:821CrossRefPubMedPubMedCentral
6.
Wibe A, Eriksen MT, Syse A, Myrvold HE, Søreide O, Norwegian Rectal Cancer Group (2003) Total mesorectal excision for rectal cancer: what can be achieved by a national audit? Colorectal Dis 5:471–477CrossRefPubMed
7.
Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicenter, randomized trial. Lancet 373:811–820CrossRefPubMedPubMedCentral
8.
Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650CrossRefPubMed
9.
Marks JH, Frenkel JL, D’Andrea AP, Greenleaf CE (2011) Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am 20:501–520CrossRefPubMed
10.
Ricciardi R, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Baxter NN (2012) Variability in reconstructive procedures following rectal cancer surgery in the United States. Dis Colon Rectum 53:874–880CrossRef
11.
Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147:724–731CrossRefPubMed
12.
Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ (2015) Variations in laparoscopic colectomy utilization in the United States. Dis Colon Rectum 58:950–956CrossRefPubMed
13.
14.
Fleshman J, Branda M, Sargent DJ 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 314:1346–1355CrossRefPubMed
15.
Marks G, Mohiuddin M, Rakinic J (1991) New hope and promise for sphincter preservation in the management of cancer of the rectum. Semin Oncol 18:388–398PubMed
16.
Marks G, Bannon J, Marks J (1996) Transanal-abdominal Transanal radical proctosigmoidectomy with coloanal anastomosis for distal rectal cancer. In: Baker R, Fisher J, Nyhus L (eds) Mastery of surgery, 3rd edn. Little, Brown and Company Inc, Boston, pp 1524–1534
17.
Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707CrossRefPubMed
18.
Marks JH, Frenkel JL, Greenleaf CE, D’Andrea AP (2014) Transanal endoscopic microsurgery with entrance into the peritoneal cavity: Is it safe? Dis Colon Rectum 57:1176–1182CrossRefPubMed
19.
Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 56:301–307CrossRefPubMed
20.
Marks JH (2009) Transanal proctectomy using TEM endoscope: initial experience. Unpublished raw data
21.
de Lacy AM, Rattner DW, Adelsdorfer C et al (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)–short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172CrossRefPubMed
22.
Washington K, Berlin J, Branton P, Cancer Committee, College of American Pathologists et al (2008) Protocol for the examination of specimens from patients with primary carcinomas of the colon and rectum. Arch Pathol Lab Med 132:1182–1193PubMed
23.
National Comprehensive Cancer Network (2016) NCCN clinical practice guidelines in oncology: rectal cancer. V.1.2016
24.
Glynne-Jones R, Mawdsley S, Novell JR (2006) The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language. Colorectal Dis 8:800–807CrossRefPubMed
25.
26.
Onaitis MW, Noone RB, Hartwig M et al (2001) Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience. Ann Surg 233:778–785CrossRefPubMedPubMedCentral
27.
Marks GJ, Marks JH, Mohiuddin M, Brady L (1998) Radical sphincter preservation surgery with coloanal anastomosis following high-dose external irradiation for the very low lying rectal cancer. Recent Results Cancer Res 146:161–174CrossRefPubMed
28.
Marks G, Mohiuddin M, Masoni L et al (1992) High-dose preoperative radiation therapy as the key to extending sphincter preservation surgery for cancer of the distal rectum. Surg Oncol Clin N Am 1:71–85
29.
Marks G, Mohiuddin M, Goldstein SD (1988) Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int J Radiat Oncol Biol Phys 15:1065–1068CrossRefPubMed
30.
Mohammed S, Anaya DA, Awad SS, Albo D, Berger DH, Artinyan A (2015) Sphincter preservation rates after radical resection for rectal cancer in the United States veteran population: opportunity for improvement in early disease. Ann Surg Oncol 22:216–223CrossRefPubMed
31.
Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35CrossRefPubMed
32.
Buess G, Kipfmuller K, Ibald R et al (1988) Clinical results of transanal endoscopic microsurgery. Surg Endosc 2:245–250CrossRefPubMed
33.
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205CrossRefPubMed
34.
Steele SR, Maykel JA, Champagne BJ, Orangio GR (2014) Complexities in colorectal surgery: decision-making and management. Springer, New YorkCrossRef
35.
Zhou X, Su M, Hu K et al (2016) CT pelvimetry and clinicopathological parameters in evaluation of the technical difficulties in performing open rectal surgery for mid-low rectal cancer. Oncol Lett 11:31–38PubMed
36.
Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734CrossRefPubMed
37.
Parfitt JR, Driman DK (2007) The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol 60:849–855CrossRefPubMed
38.
Marks JH, Valsdottir EB, Rather AA, Nweze IC, Newman DA, Chernick MR (2010) Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum 53:1023–1029CrossRefPubMed
39.
Stevenson AL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363CrossRefPubMed
Metadata
Title
Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer
Authors
J. H. Marks
G. A. Montenegro
J. F. Salem
M. V. Shields
G. J. Marks
Publication date
01-07-2016
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 7/2016
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-016-1482-y

Other articles of this Issue 7/2016

Techniques in Coloproctology 7/2016 Go to the issue

Original Article

Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm

Original Article

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

Technical Advance

Hemospray treatment for bleeding intestinal anastomoses in the early postoperative period: a novel non-operative approach

Correspondence

Is ileal pouch–anal anastomosis after Whipple procedure doable?

Original Article

Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National Surgical Quality Improvement Program

Original Article

Hemorrhoid laser procedure for second- and third-degree hemorrhoids: results from a multicenter prospective study