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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2016

01-04-2016 | Colorectal Cancer

Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study

Authors: Chien-Chih Chen, MD, Yi-Ling Lai, MD, Jeng-Kae Jiang, MD, PhD, Chun-Ho Chu, MD, I-Ping Huang, MD, Wei-Shone Chen, MD, PhD, Andy Yi-Ming Cheng, MD, Shung-Haur Yang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2016

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Abstract

Background

Neoadjuvant chemoradiation therapy (nCRT) has been indicated for locally advanced rectal cancer. While utilization of laparoscopy in rectal cancer surgery has been popular in recent years, tumors receiving nCRT is still a surgical challenge. Transanal total mesorectal excision (TaTME) has emerged as a focused area of laparoscopic surgery that is becoming an increasingly acceptable approach in the field of rectal surgery.

Methods

Between December 2013 and April 2015, a total of 50 patients (38 males) with post-nCRT middle or lower rectal cancer who then underwent TaTME at two separate institutions were prospectively documented. Overall, 100 matched control cohorts who received conventional laparoscopic rectal surgery (LapTME) were simultaneously retrieved from a prospectively registered database. Four parameters of sex, age, clinical stage, and American Society of Anesthesiologists (ASA) score were matched for surgical outcomes, and short-term oncological results, including complications and pathological outcomes, were analyzed.

Results

Both the TaTME and LapTME groups received 5-fluorouracil-based chemotherapy and 5 weeks of long-course radiation therapy. Mean operative time for the TaTME group was 182.1 ± 55.4 min (156.6 ± 37.8 min in two-team-approach cases) and 178.7 ± 34.8 min for the LapTME group. The TaTME group yielded longer distal margin lengths. No significant differences were observed in blood loss, intraoperative complication rate, conversion rate, anastomosis type, and free circumferential margin rate.

Conclusion

This matched case–control study demonstrated that TaTME is safe and feasible. Compared with LapTME, TaTME not only achieves identical circumferential margin status without compromising other operative and quality parameters but also benefits patients by achieving a longer distal margin. Thus, TaTME has the potential to become an option in managing irradiated rectal cancer.
Literature
1.
Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24(5):1205–10.CrossRefPubMed
2.
Sylla P, Bordeianou LG, Berger D, et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc. 2013;27(9):3396–405.CrossRefPubMed
3.
Velthuis S, van den Boezem PB, van der Peet DL, Cuesta MA, Sietses C. Feasibility study of transanal total mesorectal excision. Br J Surg. 2013;100(6):828–31; discussion 831CrossRefPubMed
4.
Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg. 2015;261(2):228–33.CrossRefPubMed
5.
Rouanet P, Mourregot A, Azar CC, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum. 2013;56(4):408–15.CrossRefPubMed
6.
de Lacy AM, Rattner DW, Adelsdorfer C, et al. 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. 2013;27(9):3165–72.CrossRefPubMed
7.
Chen CC, Lai YL, Jiang JK, et al. The evolving practice of hybrid natural orifice transluminal endoscopic surgery (NOTES) for rectal cancer. Surg Endosc. 2015;29(1):119–26.CrossRefPubMed
8.
Atallah S, Martin-Perez B, Albert M, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol. 2014;18(5):473–80.CrossRefPubMed
9.
van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRefPubMed
10.
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.CrossRefPubMed
11.
Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372(14):1324–32.CrossRefPubMed
12.
Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg. 2014;260(6):993–9.CrossRefPubMed
13.
Fernandez-Hevia M, Delgado S, Castells A, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261(2):221–7.CrossRefPubMed
14.
Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27(31):5124–30.CrossRefPubMedPubMedCentral
15.
Ng KH, Ng DC, Cheung HY, et al. Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg. 2009;249(1):82–6.CrossRefPubMed
16.
Wolthuis AM, Penninckx F, Fieuws S, D’Hoore A. Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Colorectal Dis. 2012;14(5):634–41.CrossRefPubMed
17.
Chen CC, Huang IP, Liu MC, Jian JJ, Cheng SH. Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery? Surg Endosc. 2011;25(5):1477–83.CrossRefPubMed
18.
Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg. 2015;261(2):234–6.CrossRefPubMed
19.
Meng W, Lau K. Synchronous laparoscopic low anterior and transanal endoscopic microsurgery total mesorectal resection. Minim Invasive Ther Allied Technol. 2014;23(2):70–3.CrossRefPubMed
20.
Rhoads JE, Schwegman CW. One-stage combined abdominoperineal resection of the rectum (miles) performed by two surgical teams. Surgery. 1965;58:600–6.PubMed
21.
Hasegawa S, Takshashi R, Hida K, et al. Transperineal minimally invasive approach in Miles operation. American Society of Colon and Rectal Surgeons Annual Scientific Meeting; 30 May–3 June 2015: Boston (MA).
22.
Heald RJ. A new solution to some old problems: transanal TME. Tech Coloproctol. 2013;17(3):257–8.CrossRefPubMed
23.
Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235(4):449–57.CrossRefPubMedPubMedCentral
24.
25.
Kang J, Hur H, Min BS, Lee KY, Kim NK. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol. 2012;19(1):154–5.CrossRefPubMed
26.
Takada M, Ichihara T, Kuroda Y. Identification of hiatal ligament for laparoscopic total mesorectal excision. Hepatogastroenterology. 2005;52(66):1722–4.PubMed
27.
Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C. Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc. 2015;29(11):3319–23.CrossRefPubMed
28.
Metadata
Title
Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study
Authors
Chien-Chih Chen, MD
Yi-Ling Lai, MD
Jeng-Kae Jiang, MD, PhD
Chun-Ho Chu, MD
I-Ping Huang, MD
Wei-Shone Chen, MD, PhD
Andy Yi-Ming Cheng, MD
Shung-Haur Yang, MD, PhD
Publication date
01-04-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4997-y

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