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Transanal (TaTME) vs. laparoscopic total mesorectal excision for mid and low rectal cancer: a propensity score-matched analysis of early and long-term outcomes

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Transanal total mesorectal excision (TaTME) has been proposed as an alternative to laparoscopic total mesorectal excision (LapTME) in distal rectal tumors. Despite encouraging reports, mid- and long-term oncological results are limited.

In this study, we aimed at comparing TaTME versus LapTME in patients with mid and low rectal cancer.

Methods

From January 2012 to December 2019, all patients undergoing either TaTME or LapTME for rectal adenocarcinoma ≤ 12 cm from the anal verge were included. Demographic, clinical, and follow-up data were retrieved from a prospective and audited database, and a propensity score-matched analysis was performed.

Results

A total of 144 patients were included, 38 underwent TaTME, and 106 LapTME. The median age was 68.0 (60.2–75.8) years, and 96 (66.7%) patients were male. Median follow-up was 30.6 (20.2–39.8) months in the TaTME group and 49.5 (22.6–68.5) months in the LapTME group.

There was one (2.6%) local recurrence in the TaTME group and two (1.9%) in the LapTME group (p = 0.788). There was no difference in the 3-year disease-free survival between groups both in the primary (93% vs. 86%, p = 0.274) and the propensity score-matched analyses (93% vs. 81%, p = 0.132).

Conversion to open surgery was less frequent in the TaTME group (none vs. 4 (11.4%), p = 0.041). Intra- and postoperative complications, length of stay, specimen quality, and resection margins were similar between groups.

Conclusions

In our experience, TaTME was associated with a less frequent conversion to open surgery but otherwise had similar post-operative results compared to LapTME. Local recurrence and 3-year survival rates were similar.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans MW, Moons LMG, Tanis PJ, de Graaf EJR, Cunningham C, Denost Q et al (2020) Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment. Br J Surg 107:1719–1730. https://doi.org/10.1002/bjs.12040

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY et al (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 15:767–774. https://doi.org/10.1016/s1470-2045(14)70205-0

    Article  PubMed  Google Scholar 

  3. Chen H, Ma B, Gao P, Wang H, Song Y, Tong L, Li P, Wang Z (2017) Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol 15:229. https://doi.org/10.1186/s12957-017-1304-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Acuna SA, Chesney TR, Ramjist JK, Shah PS, Kennedy ED, Baxter NN (2019) Laparoscopic versus open resection for rectal cancer: a noninferiority meta-analysis of quality of surgical resection outcomes. Ann Surg 269:849–855. https://doi.org/10.1097/sla.0000000000003072

    Article  PubMed  Google Scholar 

  5. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218. https://doi.org/10.1016/s1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  6. 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. https://doi.org/10.1016/s0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  7. Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989. https://doi.org/10.1002/bjs.6662

    Article  CAS  PubMed  Google Scholar 

  8. 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. https://doi.org/10.1007/s00464-010-0965-6

    Article  PubMed  Google Scholar 

  9. 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. https://doi.org/10.1007/s00464-015-4615-x

    Article  PubMed  Google Scholar 

  10. Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380. https://doi.org/10.1186/s12885-016-2428-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wasmuth HH, Faerden AE, Myklebust T, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Kørner H, Larsen SG et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–130. https://doi.org/10.1002/bjs.11459

    Article  CAS  PubMed  Google Scholar 

  12. Roodbeen SX, Penna M, Mackenzie H, Kusters M, Slater A, Jones OM, Lindsey I, Guy RJ, Cunningham C, Hompes R (2019) Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc 33:2459–2467. https://doi.org/10.1007/s00464-018-6530-4

    Article  PubMed  Google Scholar 

  13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296. https://doi.org/10.1371/journal.pmed.0040296

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  15. Song SB, Wu GJ, Pan HD, Yang H, Hu ML, Li Q, Yan QX, Xiao G (2018) The quality of total mesorectal excision specimen: a review of its macroscopic assessment and prognostic significance. Chronic Dis Transl Med 4:51–58. https://doi.org/10.1016/j.cdtm.2018.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  16. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D (2017) Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv22-iv40. https://doi.org/10.1093/annonc/mdx224

  17. Haukoos JS, Lewis RJ (2015) The propensity score Jama 314:1637–1638. https://doi.org/10.1001/jama.2015.13480

    Article  CAS  PubMed  Google Scholar 

  18. 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. https://doi.org/10.1097/sla.0000000000002653

    Article  PubMed  Google Scholar 

  19. Mege D, Hain E, Lakkis Z, Maggiori L, la Denise PÀ, J, Panis Y, (2018) Is trans-anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case-matched study in 68 patients. Colorectal Dis 20:O143-o151. https://doi.org/10.1111/codi.14238

    Article  CAS  PubMed  Google Scholar 

  20. Atallah SB, DuBose AC, Burke JP, Nassif G, deBeche-Adams T, Frering T, Albert MR, Monson JRT (2017) Uptake of transanal total mesorectal excision in North America: initial assessment of a structured training program and the experience of delegate surgeons. Dis Colon Rectum 60:1023–1031. https://doi.org/10.1097/dcr.0000000000000823

    Article  PubMed  Google Scholar 

  21. Fearnhead NS, Acheson AG, Brown SR, Hancock L, Harikrishnan A, Kelly SB, Maxwell-Armstrong CA, Sagar PM, Siddiqi S, Walsh CJ et al (2020) The ACPGBI recommends pause for reflection on transanal total mesorectal excision. Colorectal Dis 22:745–748. https://doi.org/10.1111/codi.15143

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Detering R, Roodbeen SX, van Oostendorp SE, Dekker JT, Sietses C, Bemelman WA, Tanis PJ, Hompes R, Tuynman JB (2019) Three-year nationwide experience with transanal total mesorectal excision for rectal cancer in the netherlands: a propensity score-matched comparison with conventional laparoscopic total mesorectal excision. J Am Coll Surg 228:235-244.e231. https://doi.org/10.1016/j.jamcollsurg.2018.12.016

    Article  PubMed  Google Scholar 

  23. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A et al (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. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  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. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  25. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580. https://doi.org/10.1001/jama.2017.7219

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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. https://doi.org/10.1097/sla.0000000000001948

    Article  PubMed  Google Scholar 

  27. Aubert M, Mege D, Panis Y (2020) Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach-a meta-analysis. Surg Endosc 34:3908–3919. https://doi.org/10.1007/s00464-019-07160-8

    Article  PubMed  Google Scholar 

  28. Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R, Adamina M, Tekkis PP (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg 270:59–68. https://doi.org/10.1097/sla.0000000000003227

    Article  PubMed  Google Scholar 

  29. Van Oostendorp SE, Belgers HJE, Hol JC, Doornebosch PG, Belt EJT, Oosterling SJ, Kusters M, Bonjer HJJ, Sietses C, Tuynman JB (2021) The learning curve of transanal total mesorectal excision for rectal cancer is associated with local recurrence: results from a multicentre external audit. Colorectal Dis. https://doi.org/10.1111/codi.15722

    Article  PubMed  PubMed Central  Google Scholar 

  30. Persiani R, Agnes A, Belia F, D’Ugo D, Biondi A (2020) The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience. Surg Endosc. https://doi.org/10.1007/s00464-020-08115-0

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357. https://doi.org/10.1097/00000478-200203000-00009

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Prof. Pietro Majno-Hurst for English revisions.

Author information

Author notes

  1. Martino Munini and SotiriosGeorgios Popeskou contributed equally to the work. Drs. Dimitri Christoforidis and Francesco Mongelli contributed equally to the work.

Authors and Affiliations

  1. Department of Surgery, Lugano Regional Hospital, via Tesserete 46, Lugano, 6900, Switzerland

    Martino Munini, Sotirios Georgios Popeskou, Raffaello Roesel, Francesco Mongelli & Dimitri Christoforidis

  2. Department of Surgery, Beata Vergine Hospital, Via Alfonso Turconi 23, Mendrisio, 6850, Switzerland

    Ken Galetti

  3. Faculty of Biomedicine, University of Southern Switzerland, via Buffi 13, Lugano, 6900, Switzerland

    Francesco Mongelli & Dimitri Christoforidis

  4. Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, CHUV, Lausanne, 1011, Switzerland

    Dimitri Christoforidis

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  1. Martino Munini
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Contributions

Protocol/project development: MM, DC. Data acquisition and interpretation: MM, SGP, FM. Statistical analysis: FM, RR. Manuscript drafting. MM, FM, SGP, KG. Manuscript revision and accountability for all aspects of the work.

DC, KG, FM. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Francesco Mongelli.

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Written consent was obtained from all patients and the study was approved by the local ethical committee (Comitato Etico Cantonale Ticino).

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Written consent for publication was obtained from all patients.

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The authors declare no competing interests.

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Munini, M., Popeskou, S.G., Galetti, K. et al. Transanal (TaTME) vs. laparoscopic total mesorectal excision for mid and low rectal cancer: a propensity score-matched analysis of early and long-term outcomes. Int J Colorectal Dis 36, 2271–2279 (2021). https://doi.org/10.1007/s00384-021-04019-0

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