Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany

Vinzenz Völkel,Sabine Schatz,Alois Fürst,Teresa Draeger,Monika Klinkhammer-Schalke,Michael Gerken

doi:10.1007/s00464-021-08384-3

Abstract

BackgroundSince 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center.Patients and methodsData were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan–Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis.ResultsDuring the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien–Dindo 3–4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%.ConclusionTaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.

Highlights

Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer
The present study reports on short- and oncologic long-term outcomes of the first patients treated with TaTME in one of currently four German hospitals participating in the COLOR III study
The surgical team completed several TaTME training courses according to the Consensus on structured training curriculum for transanal total mesorectal excision [21] before the first patient was treated in this technique

Summary

Introduction

Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. The so-called transanal total mesorectal excision (TaTME) technique represents the latest development in the field of minimally invasive surgery for low and very low rectum tumors Following this approach, tumor resection is achieved by a combination of laparoscopic abdominal and endoscopic transanal preparation. TaTME is supposed to improve visibility and access to the dissection planes in the pelvis leading to a greater degree of radical resection, lower rates of Surgical Endoscopy anastomotic leakage, more sphincter-saving procedures, and a better preservation of the urogenital function [3, 4]. It was first performed in 2009 and described in 2010 by Sylla et al [5]. The present study reports on short- and oncologic long-term outcomes of the first patients treated with TaTME in one of currently four German hospitals participating in the COLOR III study

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