Abstract
Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center. Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted. Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented with a threatened CRM upon pretherapeutic MRI. Abdominal conversion rate was 5.7% with no conversion for the transanal dissection. Early anastomotic leakage occurred in 7.0% of the patients. Mesorectum specimen was complete in 87.3%, R1 resection rate was 4.5% (involved distal resection margin) and in 7.6%, the CRM was positive. The three-year local recurrence rate of 58 patients with a follow-up ≥ 36 months was 3.4%. Overall survival was 92.0% after 12 months, and 82.2% after 36 months. Conclusion: TaTME can be performed safely with acceptable long-term oncological outcome. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates.
Highlights
The laparoscopic approach for total mesorectal excision (TME) is proven to be non-inferior in oncological outcome compared to open surgery
The aim of the present study is to report our single-center experience of implementation of transanal approach for TME (TaTME) for mid and low rectal cancer, including all learning curve cases and evaluate the merit of this procedure in the management of rectal cancer
DiscTuhsesicoonncept of a transanal approach to rectal cancer treatment was first developed froTmhae NcoOnTcEeSppt eorfspaecttriavne,suansianlgathpeparnouaschastaonraecccteaslscraonutceer[1t7r]e. aTthmisecnotncwepatsdfiidrsntodtevelope froflmouarisNhOinTEteSrmpseorsfpreedctuicvien,guthsienagbdthoemainnaul sacacsesasntraacucmesas; hroowuteeve[r1,7i]t.iTmhpirsovceodnctheept did n flourish in terms of reducing the abdominal access trauma; it improved the di section of the lower third of the rectum close to the pelvic floor by direct visualization the structures and the ability to access the supralevatoric rectum through a direct, straig dissection of the lower third of the rectum close to the pelvic floor by direct visualization of the structures and the ability to access the supralevatoric rectum through a direct, straight access
Summary
The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates. The quality of the TME specimen, as well as involved circumferential resection margin (CRM), have shown to be predictive for local recurrence and cancer-free survival [3,4,5]. Mid- and long-term oncological outcome of laparoscopic surgery is similar to open resection, with a 3-year locoregional recurrence rate of 5% each [8]. High positive CRM (17.2%) and conversion rates of up to 16.0% in experienced centers are reported for laparoscopic surgery [8,9]
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