Skip to main content

Advertisement

SpringerLink
Log in

Clinical outcomes of transanal total mesorectal excision using a lateral-first approach for low rectal cancer: a propensity score matching analysis

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although transanal total mesorectal excision (ta-TME) is adopted for rectal cancer surgery by an increasing number of surgeons, it is still technically challenging. We have employed a lateral-first approach for ta-TME to overcome technical difficulties. However, its outcomes and advantage over conventional laparoscopic TME remain unclear.

Methods

Thirty-five consecutive patients who underwent ta-TME using a lateral-first approach (the ta-TME group) and 53 consecutive patients who underwent conventional laparoscopic TME (the lap-TME group) for low rectal cancer were included. Propensity score matching (PSM) was used to create balanced cohorts of ta-TME (n = 28) and lap-TME (n = 28). Their clinical outcomes were compared after PSM.

Results

The operative time and intraoperative blood loss were significantly lower in the ta-TME group than in the lap-TME group (P = 0.042 and P < 0.001, respectively). Postoperative complications ≥ Clavien–Dindo grade II were significantly less and postoperative hospital stay was significantly shorter in the ta-TME group (35.7% vs. 78.6%, P = 0.003, and 18 days vs. 32 days, P < 0.001, respectively). The distal margin was significantly larger in the ta-TME when excluding the abdominoperineal resection cases (20 mm vs. 10 mm, P = 0.032). The positive radial margin was observed in 2 of 28 patients (7.1%) in the ta-TME group.

Conclusions

Ta-TME using a lateral-first approach is feasible and may offer several advantages over lap-TME in terms of short-term outcomes. It might be an alternative safe approach for ta-TME. To confirm the oncological superiority of this surgery, further study in a larger population and for a longer follow-up period is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Matsuda T, Yamashita K, Hasegawa H, Oshikiri T, Hosono M, Higashino N, Yamamoto M, Matsuda Y, Kanaji S, Nakamura T, Suzuki S, Sumi Y, Kakeji Y (2018) Recent updates in the surgical treatment of colorectal cancer. Ann Gastroenterol Surg 2:129–136

    Article  Google Scholar 

  2. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (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

    Article  CAS  Google Scholar 

  3. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR Jr, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JRT, Wren SM, Pisters PWT, Nelson H (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269:589–595

    Article  Google Scholar 

  4. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, Investigators AL (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363

    Article  CAS  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, Sylla P, Martinez-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 27:3165–3172

    Article  Google Scholar 

  7. Deijen CL, Tsai A, Koedam TW, Veltcamp Helbach M, Sietses C, Lacy AM, Bonjer HJ, Tuynman JB (2016) Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 20:811–824

    Article  CAS  Google Scholar 

  8. Lee L, Kelly J, Nassif GJ, deBeche-Adams TC, Albert MR, Monson JRT (2018) Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma. Surg Endosc 34:1534

    Article  Google Scholar 

  9. Courval V, Drolet S, Bouchard A, Bouchard P (2019) The role of transanal (Ta) dissection in the management of difficult primary and recurrent rectal cancer. BMJ Open Gastroenterol 6:e000305

    Article  Google Scholar 

  10. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, Ta TMERC (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  Google Scholar 

  11. de Lacy FB, van Laarhoven J, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32:2442–2447

    Article  Google Scholar 

  12. Koedam TWA, Veltcamp Helbach M, Penna M, Wijsmuller A, Doornebosch P, van Westreenen HL, Hompes R, Bonjer HJ, Sietses C, de Graaf E, Tuynman JB (2019) Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis. Surg Endosc 33:103–109

    Article  CAS  Google Scholar 

  13. Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2019) Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 33:79–87

    Article  Google Scholar 

  14. Kang S-B, Park JW, Jeong S-Y, Nam BH, Choi HS, Kim D-W, Lim S-B, Lee T-G, Kim DY, Kim J-S, Chang HJ, Lee H-S, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim D-H, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645

    Article  Google Scholar 

  15. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  Google Scholar 

  16. Matsuda T, Sumi Y, Yamashita K, Hasegawa H, Yamamoto M, Matsuda Y, Kanaji S, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y (2018) Outcomes and prognostic factors of selective lateral pelvic lymph node dissection with preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Colorectal Dis 33:367–374

    Article  Google Scholar 

  17. Dickson EA, Penna M, Cunningham C, Ratcliffe FM, Chantler J, Crabtree NA, Tuynman JB, Albert MR, Monson JRT, Hompes R (2019) Carbon dioxide embolism associated with transanal total mesorectal excision surgery: a report from the international registries. Dis Colon Rectum 62:794–801

    Article  Google Scholar 

  18. Atallah S, DuBose A (2015) A mechanism for constructing a durable purse-string during transanal total mesorectal excision. Tech Coloproctol 19:751–752

    Article  CAS  Google Scholar 

  19. Martin-Perez B, Otero-Pineiro A, Lacy AM (2018) Purse-string rupture: pitfalls of transanal total mesorectal excision (Cecil approach). Tech Coloproctol 22:393–394

    Article  CAS  Google Scholar 

  20. Spinelli A, Carvello M, D'Hoore A, Foppa C (2019) Integration of transanal techniques for precise rectal transection and single-stapled anastomosis: a proof of concept study. Colorectal Dis 21:841–846

    Article  CAS  Google Scholar 

  21. Balaphas A, Dumont C, Faes S, Scarpa CR, Roche B, Ris F, Buchs NC, Hahnloser D (2018) Colonic conduit prolapse after transanal total mesorectal excision (taTME). Tech Coloproctol 22:475–477

    Article  CAS  Google Scholar 

  22. Gys B, Patteet E, Van den Broeck S, Hubens G, Komen N (2018) Robotic posterior suturepexy for colonic prolapse two years after transanal total mesorectal excision for low rectal cancer. Dis Colon Rectum 61:1454

    Article  Google Scholar 

  23. Wasmuth HH, Faerden AE, Myklebust TÅ, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Kørner H, Larsen SG, Norwegian TaTME Collaborative Group, on behalf of the Norwegian Colorectal Cancer Group, Forsmo HM, Baekkelund O, Lavik S, Knapp JC, Sjo O, Rashid G (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107(1):121–130

    Article  CAS  Google Scholar 

  24. Japanese Society for Cancer of the Colon and Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma, Thrid English edn. Kanehara, Tokyo

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Takeru Matsuda, Kimihiro Yamashita, Hiroshi Hasegawa, Masataka Fujikawa, Hiroki Sakamoto, Masashi Yamamoto, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki & Yoshihiro Kakeji

  2. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan

    Takeru Matsuda

Authors
  1. Takeru Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimihiro Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masataka Fujikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroki Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masashi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shingo Kanaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Taro Oshikiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tetsu Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Satoshi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshihiro Kakeji
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeru Matsuda.

Ethics declarations

Disclosures

Takeru Matsuda, Kimihiro Yamashita, Hiroshi Hasegawa, Masataka Fujikawa, Hiroki Sakamoto, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 280084 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuda, T., Yamashita, K., Hasegawa, H. et al. Clinical outcomes of transanal total mesorectal excision using a lateral-first approach for low rectal cancer: a propensity score matching analysis. Surg Endosc 35, 971–978 (2021). https://doi.org/10.1007/s00464-020-08024-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08024-2

Keywords

Search

Navigation