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Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial

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Abstract

Introduction

Total mesorectal excision (TME) is the standard procedure for middle lower rectal cancer, and transanal total mesorectal excision (taTME) was founded as a valid alternative to the open and laparoscopic TME. The quality of the procedure performed is important for prognosis of patients. This study was designed to compare the pathological results of taTME with those of laparoscopic TME (laTME), based on the data from a randomized control trial (RCT: NCT02966483).

Methods

Between April 2016 and November 2018, all rectal cancer patients who underwent taTME or laTME in the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) and enrolled in the RCT were included in this study. The data from all participants were prospectively input in a standardized database.

Results

In total 128 patients were included in the taTME group and 133 patients were included in the laTME group. The demographics and tumor characteristics were not significantly different between the two group. T3 or N0 lesions were most common in both groups. The mesorectum specimen was complete or nearly complete in all patients. The positive distal resection margin (DRM) was detected in 2 (1.5%) cases in the laTME group versus no cases in the taTME group (P = 0.498), and the distance between the tumor and DRM in the taTME group (1.4 ± 1.1) may have the longer tendency than that in the laTME group (1.3 ± 0.9) (P = 0.745). The positive circumferential resection margin was detected in 2 cases in each group (P = 0.674). The median number of resected lymph nodes was 15.0 in taTME group versus 16.0 in the laTME group (P = 0.069).

Conclusion

The pathological outcomes between transanal and laparoscopic total mesorectal excision are similar. The rate of positive resection margin could not be significant decreased, nonetheless the decrease trend could be shown.

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Acknowledgements

Thanks for Dr. Jian Gong and Dr. Weiwei Shi’s scientific editing. Thanks to Zijun Huang for collecting some part of data.

Funding

This project was supported by the grant from the Fundamental Research Funds for the Central Universities (Grant No. 16ykjc25 to Liang Kang) and Sun Yat-sen University Clinical Research 5010 Program (Grant No. 2016005 to Liang Kang).

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Author notes

  1. Ziwei Zeng and Shuangling Luo have contributed equally to this study.

Authors and Affiliations

  1. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China

    Ziwei Zeng, Shuangling Luo, Junji Chen, Yonghua Cai, Xingwei Zhang & Liang Kang

  2. Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China

    Ziwei Zeng, Shuangling Luo, Junji Chen, Yonghua Cai, Xingwei Zhang & Liang Kang

  3. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China

    Ziwei Zeng, Shuangling Luo, Junji Chen, Yonghua Cai, Xingwei Zhang & Liang Kang

Authors
  1. Ziwei Zeng
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  2. Shuangling Luo
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  3. Junji Chen
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Correspondence to Liang Kang.

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Disclosure

Drs. Zeng, Luo, Chen, Cai, Zhang, and Kang have no conflicts of interest or financial ties to disclose. All authors are aware of and agree to the content of the paper and them being listed as an author on the paper.

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Zeng, Z., Luo, S., Chen, J. et al. Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial. Surg Endosc 34, 3956–3962 (2020). https://doi.org/10.1007/s00464-019-07167-1

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  • DOI: https://doi.org/10.1007/s00464-019-07167-1

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