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Surgical Endoscopy

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01-12-2017

Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer

Authors: John H Marks, Elizabeth A. Myers, Erik L. Zeger, Albert S. Denittis, Mounica Gummadi, Gerald J. Marks

Published in: Surgical Endoscopy | Issue 12/2017

Abstract

Background

The challenge of performing a good total mesorectal excision (TME) dissection, particularly in the distal 1/3 of the rectum, has spurred interest in new techniques. Robotic surgery is advocated by some, and more recently, a “new” approach, the transanal total mesorectal excision, has been popularized to address this problem. While great interest in this technique exists, little long-term outcome data are available. We have been utilizing a transanal abdominal transanal approach to TME in order to facilitate the distal dissection, and here, we provide our long-term outcomes using this approach in the management of rectal cancer.

Methods

From a prospectively maintained rectal cancer database, we identified 373 consecutive rectal cancers treated with sphincter preservation surgery through a combined transanal and abdominal approach to TME. Perioperative, pathological, and oncologic outcomes were analyzed.

Results

Three hundred and seventy-three patients with rectal cancer underwent a transanally initiated TME with mean follow-up of 5.5 years. 91% of cancers were in the distal rectum. 68.9% were men and 53.2% of cancers were tethered or fixed on presentation. 97.7% received neoadjuvant radiotherapy (mean 5405 cGy, 5-fluorouracil based); average time from completion of neoadjuvant therapy to surgery was 11 weeks. 180 and 193 patients underwent completion of their operation through open and laparoscopic abdominal approaches. 96% of TME specimens were complete/near complete, 94% had a negative circumferential resection margin, and 98.6% had a negative distal margin. Perioperative morbidity and mortality rates were 13.4 and 0.3%. Overall local recurrence (LR), DM, and Kaplan–Meier 5-year actuarial survival were 7.4, 19.5, and 90%, respectively.

Conclusion

This is the first report of long-term data using a transanal approach to TME supporting this approach for rectal cancer. Our data with 5-year follow-up show that adequate distal and circumferential margins with very good-quality TME specimens, and a low risk for LR with excellent overall survival can be achieved using this technique. Our long-term results support the promising reports of early experiences in the literature.

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Title: Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer
Authors: John H Marks
Elizabeth A. Myers
Erik L. Zeger
Albert S. Denittis
Mounica Gummadi
Gerald J. Marks
Publication date: 01-12-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5597-7

At a glance: The STEP trials

Springer Medicine

Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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