Skip to main content

Advertisement

SpringerLink
Log in

Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

There is no consensus regarding the gold standard technique for rectal cancer as Total Mesorectal Excision (TME) may be safely performed either by open or minimally invasive surgery. The laparoscopic approach, however, may carry technical difficulties. For this reason, a novel technique has emerged in the last decade combining a dual laparoscopic dissection (abdominal and transanal) to perform the TME technique (TaTME). When focusing on oncological outcomes, there is a lack of literature regarding mid-long term results.

The aim of this study is to evaluate the mid-term oncological impact of TaTME for treating rectal cancer.

Methods

A prospective multicentre study was performed in four tertiary centres including consecutive patients who underwent TaTME for mid-low rectal cancer by the same group of experienced surgeons. The analysed data included pathological results on the quality of TME and mid-term oncological outcomes.

Results

In total, 173 patients were included throughout a study period of 6 years. Our series included 70% males and 68% of patients with neoadjuvant treatments. The median follow-up was 23 [15–37.5] months. Regarding pathological results, a complete TME was achieved in 72.8%, while circumferential and distal margins were affected in 1.4 and 1.1%, respectively. Five patients developed local recurrences (3%) and 8.1% presented distant disease during the follow-up. The 2-year disease-free survival and the overall survival rates were 88% and 95%, respectively.

Conclusions

There is currently a lack of evidence in the literature regarding TaTME and oncological outcomes with no data available from randomized clinical trials. In the meantime, the reported results from different multicentre series are controversial. This study showed positive mid-term outcomes at 2 years of follow-up and supported notable oncological outcomes with TaTME. However, it must be emphasized that previous experience in minimally invasive and transanal surgeries is essential for surgeons before intending to perform TaTME.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Heald RJ (1988) The 'Holy Plane' of rectal surgery. J R Soc Med 81:503–508

    Article  CAS  Google Scholar 

  2. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. New Engl J Med 372:1324–1332

    Article  CAS  Google Scholar 

  3. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  Google Scholar 

  4. Group TESoCEc (2018) An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME). Colorectal Dis 20(Suppl 6):33–46

    Google Scholar 

  5. Andolfi C, Umanskiy K (2019) Appraisal and current considerations of robotics in colon and rectal surgery. J Laparoendosc Adv Surg Tech Part A 29:152–158

    Article  Google Scholar 

  6. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  Google Scholar 

  7. Aubert M, Mege D, Panis Y (2019) Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach-a meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-019-07160-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  Google Scholar 

  9. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP (2019) Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg 269:700–711

    Article  Google Scholar 

  10. Larsen SG, Pfeffer F, Korner H (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg 106:1120–1121

    Article  CAS  Google Scholar 

  11. Hol JC, van Oostendorp SE, Tuynman JB, Sietses C (2019) Long-term oncological results after transanal total mesorectal excision for rectal carcinoma. Tech Coloproctol 23(9):903–911

    Article  Google Scholar 

  12. Atallah S, Sylla P, Wexner SD (2019) Norway versus the Netherlands: will taTME stand the test of time? Tech Coloproctol 23:803–806

    Article  CAS  Google Scholar 

  13. Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, Tuynman JB, Lacy AM, Hanna GB, Bonjer HJ (2016) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30:3210–3215

    Article  Google Scholar 

  14. Lelong B, de Chaisemartin C, Meillat H, Cournier S, Boher JM, Genre D, Karoui M, Tuech JJ, Delpero JR (2017) A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design. BMC Cancer 17:253

    Article  Google Scholar 

  15. Francis N, Penna M, Mackenzie H, Carter F, Hompes R (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 31:2711–2719

    Article  Google Scholar 

  16. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734

    Article  Google Scholar 

  17. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  Google Scholar 

  18. Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, O'Donoghue DP, Moriarty M, Fennelly D, Sheahan K (2005) Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 47:141–146

    Article  CAS  Google Scholar 

  19. Simo V, Arredondo J, Hernan C, Jimenez LM, Ielpo B, Fernandez J, Villafane A, Pastor E (2019) Rectal cancer treatment by transanal total mesorectal excision: results in 100 consecutive patients. Cirugia espanola 97:510–516

    Article  Google Scholar 

  20. Zeng Z, Luo S, Chen J, Cai Y, Zhang X, Kang L (2019) Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial. Surg Endosc. https://doi.org/10.1007/s00464-019-07167-1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wasmuth HH, Faerden AE, Myklebust TA, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Korner H, Larsen SG, Forsmo HM, Baekkelund O, Lavik S, Knapp JC, Sjo O, Rashid G (2019) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg. https://doi.org/10.1002/bjs.11459

    Article  PubMed  Google Scholar 

  22. Roodbeen SX, de Lacy FB, van Dieren S, Penna M, Ris F, Moran B, Tekkis P, Bemelman WA, Hompes R (2019) Predictive factors and risk model for positive circumferential resection margin rate after transanal total mesorectal excision in 2653 patients with rectal cancer. Ann Surg 270:884–891

    Article  Google Scholar 

  23. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, 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 314:1346–1355

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  25. de Lacy FB, van Laarhoven J, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32:2442–2447

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Sara Rosenstone Calvo for editing this manuscript.

Funding

No funding.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, University Hospital Leon, Leon, Spain

    Vicente Simo & Jorge Arrredondo

  2. Department of Colorectal Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain

    Patricia Tejedor & Carlos Pastor

  3. Department of Colorectal Surgery, University Hospital Gregorio Marañon, Madrid, Spain

    Luis Miguel Jimenez & Jaime Zorilla

  4. Department of Epidemiology, University Hospital of Valladolid, Valladolid, Spain

    Cristina Hernan

  5. Department of Colorectal Surgery, University Clinic of Navarre, Marquesado de Sta, Marta St. #1, 28027, Madrid, Spain

    Fernando Lapuente & Carlos Pastor

Authors
  1. Vicente Simo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Tejedor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis Miguel Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Hernan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jaime Zorilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorge Arrredondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fernando Lapuente
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

Corresponding author

Correspondence to Carlos Pastor.

Ethics declarations

Disclosures

Dr. V. Simó declares an honorary contract with Medtronic. Drs. P. Tejedor, LM. Jiménez, C. Hernán, J. Zorilla, J. Arredondo, F. Lapuente and C. Pastor have no conflicts of interest or financial ties to disclose.

Research involving human and animal participants

All procedures performed in studies involving humans were in accordance with ethical standards of the institutional research committee and the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Simo, V., Tejedor, P., Jimenez, L.M. et al. Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study. Surg Endosc 35, 1808–1819 (2021). https://doi.org/10.1007/s00464-020-07579-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07579-4

Keywords

Search

Navigation