Advertisement

Surgical Endoscopy

, Volume 30, Issue 2, pp 464–470 | Cite as

Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases

  • M. Veltcamp Helbach
  • C. L. Deijen
  • S. Velthuis
  • H. J. Bonjer
  • J. B. Tuynman
  • C. Sietses
Article

Abstract

Background

Low anterior resection for distal and mid-rectal cancer is associated with high positive resection margins. Transanal total mesorectal excision (TaTME) is a new treatment in which the rectum is dissected transanally according to TME principles. The short-term results and oncological follow-up of the first 80 patients were described.

Methods

Between June 2012 and September 2014, all patients in the Gelderse Vallei Hospital and the VU University Medical Center with histologically proven distal or mid-rectal carcinomas without evidence of distant metastases underwent TaTME. Patients with T4 tumors were excluded. Transanal mobilization was performed with the aid of a single port and endoscopic instruments according to TME criteria.

Results

Eighty patients were operated in a period of 2 years. Laparotomy was recommended and performed in four patients. Postoperative morbidity was 39 %. Ten (12 %) complications were graded as severe (Clavien–Dindo grade 3, 4 and 5) and needed re-intervention. Median operative time was 204 min (range 91–447). Median hospital stay was 8 days (range 3–41). Specimens were graded as complete in 88 % of the patients, nearly complete in 9 % and incomplete in 3 %. A positive circumferential resection margin (<2 mm) was observed in two patients. During the two and half years study period, a local recurrence was observed in two patients.

Conclusion

TaTME is a safe alternative to standard laparoscopic TME in selected low-risk patients with rectal carcinoma when treated by an experienced colorectal team. In the future, randomized trials are necessary to prove its oncological safety.

Keywords

Colorectal Cancer G-I Endoscopy 

Notes

Disclosures

Dr. C. Sietses has received lecturing fee of Applied Medical and a proctor fee from Covidien. Drs. M. Veltcamp Helbach, Drs. C.L. Deijen, Drs. S. Velthuis, Prof. Dr. H.J. Bonjer and Dr. J.B. Tuynman have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482CrossRefPubMedGoogle Scholar
  2. 2.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899CrossRefPubMedGoogle Scholar
  3. 3.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJT, Pahlman L, Glimelius B, Van Krieken HJM, Leer JWH, Van de Velde CJH (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646CrossRefPubMedGoogle Scholar
  4. 4.
    Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701CrossRefPubMedGoogle Scholar
  5. 5.
    Bosch SL, Nagtegaal ID (2012) The importance of the pathologist’s role in assessment of the quality of the mesorectum. Curr Colorectal Cancer Rep 8(2):90–98PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Bondeven P, Hagemann-Madsen RH, Laurberg S, Pedersen BG (2013) Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging. Br J Surg 100(10):1357–1367CrossRefPubMedGoogle Scholar
  7. 7.
    Siegel R, Cuesta MA, Targarona E, Bader FG, Morino M, Corcelles R, Lacy AM, Påhlman L, Hagline E, Bujko K, Bruch HP, Heiss MM, Eikermann M, Neugebauer EA, European Association for Endoscopic Surgery (EAES) (2011) Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 25(8):2423–2440CrossRefPubMedGoogle Scholar
  8. 8.
    Van den Boezem PB, Sietses C (2011) Single-incision laparoscopic colorectal surgery, experience with 50 consecutive cases. J Gastrointest Surg 15(11):1989–1994CrossRefPubMedGoogle Scholar
  9. 9.
    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 20:1729–1734CrossRefPubMedGoogle Scholar
  10. 10.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopicor Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefPubMedGoogle Scholar
  11. 11.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ, Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMedGoogle Scholar
  12. 12.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Lancet Oncol 14(3):210–218CrossRefPubMedGoogle Scholar
  13. 13.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068CrossRefPubMedGoogle Scholar
  14. 14.
    Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774CrossRefPubMedGoogle Scholar
  15. 15.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMedGoogle Scholar
  16. 16.
    Wexner SD, Berho M (2014) Transanal TAMIS total mesorectal excision (TME)—a work in progress. Tech Coloproctol 18(5):423–425CrossRefPubMedGoogle Scholar
  17. 17.
    Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2014) Transanal total mesorectal excision in rectal cancer: short term outcomes in comparison with laparoscopic surgery. Ann Surg 00:1–7Google Scholar
  18. 18.
    Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28:3494–3499CrossRefPubMedGoogle Scholar
  19. 19.
    de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernández M, Delgado S, Sylla P, Martínez-Palli G (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc 27(9):3165–3172CrossRefPubMedGoogle Scholar
  20. 20.
    Emhoff IA, Lee GC, Sylla P (2014) Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES). Dig Endosc 26(Suppl 1):29–42CrossRefPubMedGoogle Scholar
  21. 21.
    Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56(4):408–415CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • M. Veltcamp Helbach
    • 1
  • C. L. Deijen
    • 2
  • S. Velthuis
    • 1
  • H. J. Bonjer
    • 2
  • J. B. Tuynman
    • 2
  • C. Sietses
    • 1
  1. 1.Department of SurgeryGelderse Vallei HospitalEdeThe Netherlands
  2. 2.Department of SurgeryVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations