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Transanal versus laparoscopic total mesorectal excision: a comparative study of long-term oncological outcomes

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Abstract

Background

Transanal total mesorectal excision (TaTME) is the most recent approach developed to improve pelvic dissection in surgery for mid and low rectal tumors. There are still inconsistencies regarding the technique’s oncological results. The aim of this study was to analyze clinical and oncological outcomes of the learning curve of TaTME in comparison to laparoscopic TME (lapTME).

Methods

Rectal cancer patients who had TaTME and lapTME in two Portuguese colorectal units between March 2016 and December 2018 were eligible. Primary endpoints were 5-year overall survival, disease-free survival, and local recurrence. Secondary endpoints were clinical and pathological outcomes.

Results

Forty-four patients underwent TaTME (29 men) and 39 lapTME (27 men) with a median age of 69 and 66 (p = 0.093), respectively. No differences were observed concerning baseline characteristics, emphasizing their comparability. In the TaTME group, there were more hand-sewn anastomosis (0 lapTME versus 7 TaTME, p = 0.018) with significantly less distance to the dentate line (40 mm lapTME versus 20 mm TaTME, p = 0.005) and significantly more loop ileostomies performed (28 lapTME versus 41 TaTME, p = 0.001). There were no differences in post-operative mortality, morbidity, readmissions, and stoma closure. Groups were similar in relation to specimen quality, margins, and resectability; however, TaTME had a significantly higher node yield (14 lapTME versus 20 TaTME, p = 0.002). Finally, no disparities were noted in oncological outcomes, namely local and distant recurrence, 5-year overall survival, and disease-free survival.

Conclusions

Even with the disadvantage of the learning curve of a new technique, TaTME appears to be comparable to lapTME, with similar long-term oncological outcomes. It has, however, a demanding learning curve, significant risk for morbidity and should be used only for selected patients.

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Availability of data and materials

The datasets analyzed during the current study are available in the Hospital Beatriz Ângelo e Hospital da Luz informatics hospital database (Soarien), available from the corresponding author on reasonable request.

Code availability

Not applicable

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Funding

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Authors and Affiliations

  1. Consultant in General and Colorectal Surgery, Surgical Department of Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal

    S. Ourô

  2. NOVA Medical School, Lisbon, Portugal

    S. Ourô

  3. Consultant in General Surgery, Surgical Department of Hospital Beatriz Ângelo, Lisbon, Portugal

    M. Ferreira

  4. Consultant in General Surgery, Surgical Department of Hospital da Luz, Lisbon, Portugal

    P. Roquete

  5. Consultant in General Surgery, Head of the Surgical Department of Hospital Beatriz Ângelo, Lisbon, Portugal

    R. Maio

  6. Full Professor of Surgery, NOVA Medical School, Lisbon, Portugal

    R. Maio

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  1. S. Ourô
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  2. M. Ferreira
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  4. R. Maio
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Contributions

SO: study conception and design, acquisition, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article. MF: interpretation of the data, critical revision of the article for important intellectual content, and final approval of the article. PR: interpretation of the data, critical revision of the article for important intellectual content, and final approval of the article. RM: critical revision of the article for important intellectual content and final approval of the article.

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Correspondence to S. Ourô.

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The present study was approved by the Ethics Committee and Institutional Review Board of Hospital Beatriz Ângelo and Hospital da Luz with no formal Informed consent required due to its methodology and anonymity. The study protocol was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Ourô, S., Ferreira, M., Roquete, P. et al. Transanal versus laparoscopic total mesorectal excision: a comparative study of long-term oncological outcomes. Tech Coloproctol 26, 279–290 (2022). https://doi.org/10.1007/s10151-022-02570-8

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