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Techniques in Coloproctology

, Volume 20, Issue 7, pp 467–473 | Cite as

Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer

  • J. H. Marks
  • G. A. Montenegro
  • J. F. Salem
  • M. V. Shields
  • G. J. Marks
Original Article

Abstract

Background

Natural orifice translumenal endoscopic surgery (NOTES) has always made more sense in the colorectal field where the target organ for entry houses the pathology. To address the question whether an adequate total mesorectal excision (TME) for rectal cancer can be performed from a transanal bottoms-up approach, we performed a case-matched study.

Methods

Starting in 2009, transanal TME (taTME) surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database. Between March 2012 and February 2014, 17 consecutive taTME rectal cancer patients were identified and case-matched to multiport laparoscopic TME (MP TME) based on age, body mass index, uT stage, radiation dose, level in the rectum, and procedure. Perioperative outcomes, morbidity, mortality, local recurrence, completeness of TME, and radial and distal margins were analyzed. Statistically significant differences were identified using Student’s t test.

Results

There were 12 transanal abdominal transanal (TATA)/5 abdominoperineal resection procedures in each group. Data regarding overall/taTME/MP TME are as follows: % positive-circumferential margin: 2.9/0/5.9 % (p = 0.32). Distal margin: 0/0/0 %. Complete or near-complete TME: 97.1/100/94.1 % (p = 0.32). Incomplete TME 2.9/0/5.9 % (p = 0.32). Local recurrence: 2.9/5.9/0 % (p = 0.32). There were no perioperative mortalities. Morbidity in each group: 26.4/23.5/29.4 % (p = 0.79). There were no differences in perioperative or postoperative outcomes except days to clear liquids (1/2 days, p = 0.03) and largest incision length (1.3/2.6 cm, p = 0.05).

Conclusions

We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottoms-up TME compared to standard laparoscopic TME. TaTME is a promising progressive approach to NOTES and deserves additional evaluation.

Keywords

Rectal cancer NOTES TATA TaTME TAMIS Laparoscopic surgery Sphincter-preserving surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was carried out to appropriate ethical standards.

Informed consent

Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.

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Copyright information

© Springer-Verlag Italia Srl 2016

Authors and Affiliations

  • J. H. Marks
    • 1
  • G. A. Montenegro
    • 1
    • 2
  • J. F. Salem
    • 1
  • M. V. Shields
    • 1
  • G. J. Marks
    • 1
  1. 1.Division of Colorectal SurgeryLankenau Medical CenterWynnewoodUSA
  2. 2.Division of Colorectal SurgerySaint Louis University HospitalSaint LouisUSA

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