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Techniques in Coloproctology

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01-04-2021 | Rectal Cancer | Original Article

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

Authors: S. Hallam, F. Ahmed, N. Gouvas, S. Pandey, D. Nicol

Published in: Techniques in Coloproctology | Issue 4/2021

Abstract

Background

Transanal TME (TaTME) was introduced to improve access to the pelvis in difficult cases (male sex, obesity and mid to low rectal cancers) and reduce the risk of anastomotic leak by avoiding cross stapling. In April 2018 the Norwegian hospital to whom all local; recurrences for rectal cancer are referred reported an unexpected rise in early multifocal local recurrences of 9.5% following TaTME compared with 3.4% following conventional TME leading to a nationwide moratorium on the procedure and ending, in an editorial published on the British Journal of Surgery in August 2020, by saying that other countries should consider the issue in the context of local practices and results. There are limited data concerning oncological outcomes of TaTME compared to conventional TME. The aim of this study was to report perioperative and oncological outcomes for patients with rectal cancer treated with TaTME in a high-volume, experienced UK centre.

Methods

From January 2015 to January 2020 consecutive patients with histologically confirmed rectal cancer having TaTME at Worcestershire Royal Hospital NHS were prospectively entered into an online international registry. Patients were followed according to local protocol with clinical examination, tumour markers, endoscopy and radiology.

Results

Seventy patients underwent TaTME for rectal cancer. The median distance of the tumour from the anorectal junction was 4 cm (IQR 2–5). The mesorectal margin was involved in 20 (1%) patients, all of whom received neoadjuvant chemoradiotherapy. Overall survival was 94% at a median follow-up of 15 months (IQR 9–31 months). Distant recurrence occurred in 12 (17%) of patients at a median of 14 months (IQR 10–17 months). The 18-month stoma-free survival rate was 66%.

Conclusions

A local recurrence rate of 5.7% supports the oncological safety of TaTME for rectal cancer.

Aitken RJ (1996) Mesorectal excision for rectal cancer. Br J Surg 83(2):214–216PubMed

Atallah S, Albert M, DeBeche-Adams T, Nassif G, Polavarapu H, Larach S (2013) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 17(3):321–325. https://doi.org/10.1007/s10151-012-0971-xCrossRefPubMed

Augestad KM, Keller DS, Bakaki PM, Rose J, Koroukian SM, Øresland T, Delaney CP (2018) The impact of rectal cancer tumor height on recurrence rates and metastatic location: a competing risk analysis of a national database. Cancer Epidemiol 53:56–64. https://doi.org/10.1016/j.canep.2018.01.009CrossRefPubMed

Boyle E, Braun M, Hill J, Kuryba A, Meulen J, Walker K, Eaves E, Roe A, Whitehead A (2018) National bowel cancer audit, annual report 2018

Buchs NC, Wynn G, Austin R, Penna M, Findlay JM, Bloemendaal AL, Mortensen NJ, Cunningham C, Jones OM, Guy RJ, Hompes R (2016) A two-centre experience of transanal total mesorectal excision. Colorectal Dis 18(12):1154–1161. https://doi.org/10.1111/codi.13394CrossRefPubMed

Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N, Trial SRC (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336(14):980–987. https://doi.org/10.1056/NEJM199704033361402CrossRefPubMed

Chen K, Cao G, Chen B, Wang M, Xu X, Cai W, Xu Y, Xiong M (2017) Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. Int J Surg 39:1–10. https://doi.org/10.1016/j.ijsu.2016.12.123CrossRefPubMed

Corp I (Released 2016) IBM SPSS Statistics for Windows, Version 24.0. IBM Corp

Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181(4):335–346PubMed

10.

Fearnhead NS, Acheson AG, Brown SR, Hancock L, Harikrishnan A, Kelly SB, Maxwell-Armstrong CA, Sagar PM, Siddiqi S, Walsh CJ, Wheeler JMD, Abercrombie JF, Association of Coloproctology of Great Britain IAE, Gitting It Right First Time (GIRFT) (2020) The ACPGBI recommends pause for reflection on transanal total mesorectal excision. Colorectal Dis 22(7):745–748. https://doi.org/10.1111/codi.15143CrossRefPubMedPubMedCentral

11.

Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (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):1346–1355. https://doi.org/10.1001/jama.2015.10529CrossRefPubMedPubMedCentral

12.

Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JRT, Wren SM, Pisters PWT, Nelson H (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):589–595. https://doi.org/10.1097/SLA.0000000000003002CrossRefPubMed

13.

Hajibandeh S, Eltair M, George AT, Thumbe V, Torrance AW, Budhoo M, Joy H, Peravali R (2020) Meta-analysis of transanal total mesorectal excision versus laparoscopic total mesorectal excision in management of rectal cancer. Int J Colorectal Dis 35(4):575–593. https://doi.org/10.1007/s00384-020-03545-7CrossRefPubMed

14.

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019CrossRefPubMed

15.

Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23(7):703–707. https://doi.org/10.1007/s00384-008-0470-8CrossRefPubMed

16.

Kang L, Chen YG, Zhang H, Zhang HY, Lin GL, Yang YC, Chen WH, Luo SL, Chen N, Tong WD, Shen ZL, Xiong DH, Xiao Y, Zhang ZT, Wang JP (2020) Transanal total mesorectal excision for rectal cancer: a multicentric cohort study. Gastroenterol Rep (Oxf) 8(1):36–41. https://doi.org/10.1093/gastro/goz049CrossRef

17.

de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernández M, Delgado S, Sylla P, Martínez-Palli G (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(9):3165–3172. https://doi.org/10.1007/s00464-013-2872-0CrossRefPubMed

18.

Larsen SG, Pfeffer F, Kørner H, Group NCC (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg 106(9): 1120–1121. https://doi.org/10.1002/bjs.11287

19.

Lee L, Kelly J, Nassif GJ, deBeche-Adams TC, Albert MR, Monson JRT (2020) Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma. Surg Endosc 34(4):1534–1542. https://doi.org/10.1007/s00464-018-6360-4CrossRefPubMed

20.

Leonard D, Penninckx F, Fieuws S, Jouret-Mourin A, Sempoux C, Jehaes C, Van Eycken E, PROCARE amBPoCotR (2010) Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 252(6):982–988. https://doi.org/10.1097/SLA.0b013e3181efc142CrossRefPubMed

21.

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 (3):501–520, viii–ix. https://doi.org/10.1016/j.soc.2011.01.008

22.

Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42(12):1569–1574. https://doi.org/10.1007/bf02236209CrossRefPubMed

23.

Office for National Statistics (2016) Cancer Registration Statistics, England: 2014. UK

24.

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, Collaborative TR (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266(1):111–117. https://doi.org/10.1097/SLA.0000000000001948CrossRefPubMed

25.

Perdawood SK, Kroeigaard J, Eriksen M, Mortensen P (2020) Transanal total mesorectal excision: the Slagelse experience 2013–2019. Surg Endosc. https://doi.org/10.1007/s00464-020-07454-2CrossRefPubMed

26.

Roodbeen SX, Penna M, Mackenzie H, Kusters M, Slater A, Jones OM, Lindsey I, Guy RJ, Cunningham C, Hompes R (2019) Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc 33(8):2459–2467. https://doi.org/10.1007/s00464-018-6530-4CrossRefPubMed

27.

Roodbeen SX, Spinelli A, Bemelman WA, Di Candido F, Cardepont M, Denost Q, D’Hoore A, Houben B, Knol JJ, Martín-Pérez B, Rullier E, Sands D, Setton I, Van de Steen K, Tanis PJ, Wexner SD, Hompes R, Wolthuis AM (2020) Local recurrence after transanal total mesorectal excision for rectal cancer: a multicenter cohort study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003757CrossRef

28.

Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Wilson K, Hague W, Simes J, Investigators AG-ITGAA (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg 269(4):596–602. https://doi.org/10.1097/SLA.0000000000003021CrossRefPubMed

29.

Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, Investigators A (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009CrossRefPubMed

30.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210. https://doi.org/10.1007/s00464-010-0965-6CrossRefPubMed

31.

Wasmuth HH, Faerden AE, Myklebust T, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Kørner H, Larsen SG, Forsmo HM, Baekkelund O, Lavik S, Knapp JC, Sjo O, Rashid G, Norwegian TaTME Collaborative Group obotNCCG (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107(1): 121–130. https://doi.org/10.1002/bjs.11459

Title: Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study
Authors: S. Hallam
F. Ahmed
N. Gouvas
S. Pandey
D. Nicol
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keywords: Rectal Cancer
Rectal Cancer
Enterostomy
Ileostomy
Enterostomy
Published in: Techniques in Coloproctology / Issue 4/2021
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-020-02390-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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