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Surgical Endoscopy

, Volume 31, Issue 12, pp 5248–5257 | Cite as

Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer

  • John H Marks
  • Elizabeth A. Myers
  • Erik L. Zeger
  • Albert S. Denittis
  • Mounica Gummadi
  • Gerald J. Marks
Article

Abstract

Background

The challenge of performing a good total mesorectal excision (TME) dissection, particularly in the distal 1/3 of the rectum, has spurred interest in new techniques. Robotic surgery is advocated by some, and more recently, a “new” approach, the transanal total mesorectal excision, has been popularized to address this problem. While great interest in this technique exists, little long-term outcome data are available. We have been utilizing a transanal abdominal transanal approach to TME in order to facilitate the distal dissection, and here, we provide our long-term outcomes using this approach in the management of rectal cancer.

Methods

From a prospectively maintained rectal cancer database, we identified 373 consecutive rectal cancers treated with sphincter preservation surgery through a combined transanal and abdominal approach to TME. Perioperative, pathological, and oncologic outcomes were analyzed.

Results

Three hundred and seventy-three patients with rectal cancer underwent a transanally initiated TME with mean follow-up of 5.5 years. 91% of cancers were in the distal rectum. 68.9% were men and 53.2% of cancers were tethered or fixed on presentation. 97.7% received neoadjuvant radiotherapy (mean 5405 cGy, 5-fluorouracil based); average time from completion of neoadjuvant therapy to surgery was 11 weeks. 180 and 193 patients underwent completion of their operation through open and laparoscopic abdominal approaches. 96% of TME specimens were complete/near complete, 94% had a negative circumferential resection margin, and 98.6% had a negative distal margin. Perioperative morbidity and mortality rates were 13.4 and 0.3%. Overall local recurrence (LR), DM, and Kaplan–Meier 5-year actuarial survival were 7.4, 19.5, and 90%, respectively.

Conclusion

This is the first report of long-term data using a transanal approach to TME supporting this approach for rectal cancer. Our data with 5-year follow-up show that adequate distal and circumferential margins with very good-quality TME specimens, and a low risk for LR with excellent overall survival can be achieved using this technique. Our long-term results support the promising reports of early experiences in the literature.

Keywords

Rectal cancer Transanal TME (taTME) TATA APR Sphincter preservation Laparoscopic rectal cancer TME NOTES 

Notes

Acknowledgements

Supported by Harry Mirabile Colorectal Cancer Fund of the Marks Colorectal Surgical Foundation.

Compliance with ethical standards

Disclosures

John H. Marks, Elizabeth A. Myers, Erik L. Zeger, Albert S. Denittis, Mounica Gummadi and Gerald J. Marks have no conflicts of interest of financial ties to disclose

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • John H Marks
    • 1
  • Elizabeth A. Myers
    • 1
  • Erik L. Zeger
    • 2
  • Albert S. Denittis
    • 3
  • Mounica Gummadi
    • 1
  • Gerald J. Marks
    • 1
  1. 1.Marks Colorectal Surgical Associates, Lankenau Medical CenterLankenau Institute for Medical ResearchWynnewoodUSA
  2. 2.Section of Medical Oncology, Lankenau Medical CenterLankenau Institute for Medical ResearchWynnewoodUSA
  3. 3.Section of Radiation Oncology, Lankenau Medical CenterLankenau Institute for Medical ResearchWynnewoodUSA

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