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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 1/2024

Open Access 01-12-2024 | Rectal Cancer | RESEARCH

Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A retrospective propensity score-adjusted cohort study

Authors: Yanic Ammann, Rene Warschkow, Bruno Schmied, Diego De Lorenzi, Christoph Reißfelder, Stephan Bischofberger, Lukas Marti, Walter Brunner

Published in: International Journal of Colorectal Disease | Issue 1/2024

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Abstract

Purpose

Transanal total mesorectal excision (taTME) was developed to provide better vision during resection of the mesorectum. Conflicting results have shown an increase in local recurrence and shorter survival after taTME. This study compared the outcomes of taTME and abdominal (open, laparoscopic, robotic) total mesorectal excision (abTME).

Methods

Patients who underwent taTME or abTME for stages I–III rectal cancer and who received an anastomosis were included. A retrospective analysis of a prospectively conducted database was performed. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Risk factors were adjusted by propensity score matching (PSM). The secondary endpoints were local recurrence rates and combined poor pathological outcomes.

Results

From 2012 to 2020, a total of 189 patients underwent taTME, and 119 underwent abTME; patients were followed up for a mean of 54.7 (SD 24.2) and 78.4 (SD 34.8) months, respectively (p < 0.001). The 5-year survival rates after taTME and abTME were not significantly different after PSM: OS: 78.2% vs. 88.6% (p = 0.073), CSS: 87.4% vs. 92.1% (p = 0.359), and DFS: 69.3% vs. 80.9% (p = 0.104), respectively. No difference in the local recurrence rate was observed (taTME, n = 10 (5.3%); abTME, n = 10 (8.4%); p = 0.280). Combined poor pathological outcomes were more frequent after abTME (n = 36, 34.3%) than after taTME (n = 35, 19.6%) (p = 0.006); this difference was nonsignificant according to multivariate analysis (p = 0.404).

Conclusion

taTME seems to be a good treatment option for patients with rectal cancer and is unlikely to significantly affect local recurrence or survival. However, further investigations concerning the latter are warranted.

Trial registration

ClinicalTrials.gov (NCT0496910).
Appendix
Available only for authorised users
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Metadata
Title
Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A retrospective propensity score-adjusted cohort study
Authors
Yanic Ammann
Rene Warschkow
Bruno Schmied
Diego De Lorenzi
Christoph Reißfelder
Stephan Bischofberger
Lukas Marti
Walter Brunner
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-023-04591-7

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