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Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population

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Abstract

Background

Total mesorectal excision (TME) is the gold standard for oncologic resection in low and mid rectal cancers. However, abdominal approaches to TME can be hampered by poor visibility, inadequate retraction, and distal margin delineation. Transanal TME (taTME) is a promising hybrid technique that was developed to mitigate the difficulties of operating in the low pelvis and to optimize the circumferential resection and distal margins.

Methods

The objective of this study was to characterize our experience implementing taTME at our institution in a technically challenging patient population. We performed a retrospective review of consecutive patients who underwent taTMEs between November 2013 and May 2019 for rectal cancer at a tertiary community cancer center. Outcome measures included pathologic grading of TME specimen, post-operative complications, and oncologic outcomes.

Results

Forty-four patients with mid and low rectal cancer underwent low anterior resection via taTME. The most common staging modality was rectal MRI which demonstrated T3 or T4 tumors in 89% of our patients prior to neoadjuvant. Eighty-six percent of patients underwent neoadjuvant chemoradiation. The initial cases were performed sequentially as a single team, but we later transitioned to a synchronous, two-team approach. Ninety-one percent of TME grades were complete or near complete. Only one patient (2.3%) had a positive circumferential margin. Six patients developed anastomotic leaks with an overall anastomotic complication rate of 18.2%. Two patients (4.5%) with primary rectal cancer developed local recurrence, one of which developed multifocal local recurrence.

Conclusions

Using the taTME approach on selected locally advanced low rectal cancers, especially in technically complex irradiated and obese male patients, has yielded comparably safe and effective outcomes to laparoscopic proctectomy.

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Authors and Affiliations

  1. Department of Surgery, Oregon Health and Science University, Portland, USA

    Ivy H. Gardner & Walaa F. Abdelmoaty

  2. Bronson Colon & Rectal Surgery Specialists, Kalamazoo, MI, USA

    Katherine A. Kelley

  3. Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Providence Cancer Institute, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA

    Ahmed Sharata, Amanda V. Hayman & Mark H. Whiteford

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  1. Ivy H. Gardner
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Correspondence to Mark H. Whiteford.

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Drs. Gardner, Kelley, Abdelmoaty, Sharata, Hayman, and Whiteford have no conflicts of interest or financial ties to disclose.

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Gardner, I.H., Kelley, K.A., Abdelmoaty, W.F. et al. Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population. Surg Endosc 36, 167–175 (2022). https://doi.org/10.1007/s00464-020-08251-7

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