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Abstract
Background Since Sylla and Lacy successfully reported the transanal total mesorectal excision in 2010, taTME was considered to have the potential to overcome some problematic laparoscopic cases in male, low advanced rectal cancer. However, the evidence is still lacking. This study compared the short and long outcomes of taTME with laTME in these “challenging” patients to explore the advantages of taTME among the patients. Method After propensity score matching analysis, 106 patients were included in each group from 325 patients who met the including standard. Statistical analysis was used to compare the differences of perioperative outcomes, histopathological results, and survival results between taTME and laTME groups. Results The mean time of pelvic operation in the taTME group was significantly shorter than in the laTME group (62.2 ± 14.2 mins vs 81.1 ± 18.9 mins, P = 0.003). The complication incidence rate and the rate of protective loop ileostomy in the taTME group were significantly lower than those in the laTME group (19.8% vs 38.7%, P = 0.003 and 70.8% vs 92.5%, P < 0.001). In long-term result, there was no significant difference between the two groups for 3-year OS (87.3% vs 85.4%, P = 0.86) or 3-year DFS (74.9% vs 70.1%, P = 0.92). The 2-year cumulative local recurrence rate was similar between the two groups (1.1% vs 5.8%, P = 0.22). Conclusion This study demonstrated that taTME might reduce the incidence of postoperative complications, especially of anastomotic leakage in these “challenging” patients. taTME may be considered to have clear advantages for “challenging” patients.
Highlights
Since the concept of total mesorectum excision (TME) was described by Heald in 1979 [1], it has become a gold standard for rectal cancer surgery
Since transanal total mesorectal excision was pioneered by Sylla et al [5], it has become a hot topic in treating middle to low rectal cancer
Underwent emergency surgery or abdominoperineal resection, were excluded from this study. This cohort was matched with patients who underwent laparoscopic TME (laTME) performed by experienced surgeons in our center by propensity score matching (PSM), which can minimize selection bias caused by the retrospective analysis [10, 11]
Summary
Since the concept of total mesorectum excision (TME) was described by Heald in 1979 [1], it has become a gold standard for rectal cancer surgery. According to the results of published randomized clinical trials (RCT) [2, 3], laparoscopic TME (laTME) is considered an effective alternative method to open surgery and has become the mainstream treatment for mid and low rectal cancer. While the “down-to-up” approach in taTME has been considered to largely overcome these difficult aspects of open surgery or laparoscopic surgery [7], studies reporting taTME results for “challenging” patients are still lacking. Since Sylla and Lacy successfully reported the transanal total mesorectal excision in 2010, taTME was considered to have the potential to overcome some problematic laparoscopic cases in male, low advanced rectal cancer. This study compared the short and long outcomes of taTME with laTME in these “challenging” patients to explore the advantages of taTME among the patients. This study demonstrated that taTME might reduce the incidence of postoperative complications, especially of anastomotic leakage in these “challenging” patients. taTME may be considered to have clear advantages for “challenging” patients
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