Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

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.

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. Marwan K, Staples MP, Thursfield V, Bell SW (2010) The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 53:1645–1651

    Article  CAS  PubMed  Google Scholar 

  2. Enríquez-Navascués JM, Borda N, Lizerazu A et al (2011) Patterns of local recurrence in rectal cancer after a multidisciplinary approach. World J Gastroenterol 17:1674–1684

    Article  PubMed  PubMed Central  Google Scholar 

  3. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 327:1479–1482

    Article  Google Scholar 

  4. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457

    Article  CAS  PubMed  Google Scholar 

  5. Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373:821

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wibe A, Eriksen MT, Syse A, Myrvold HE, Søreide O, Norwegian Rectal Cancer Group (2003) Total mesorectal excision for rectal cancer: what can be achieved by a national audit? Colorectal Dis 5:471–477

    Article  CAS  PubMed  Google Scholar 

  7. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicenter, randomized trial. Lancet 373:811–820

    Article  PubMed  PubMed Central  Google Scholar 

  8. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650

    Article  PubMed  Google Scholar 

  9. Marks JH, Frenkel JL, D’Andrea AP, Greenleaf CE (2011) Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am 20:501–520

    Article  PubMed  Google Scholar 

  10. Ricciardi R, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Baxter NN (2012) Variability in reconstructive procedures following rectal cancer surgery in the United States. Dis Colon Rectum 53:874–880

    Article  Google Scholar 

  11. Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147:724–731

    Article  PubMed  Google Scholar 

  12. Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ (2015) Variations in laparoscopic colectomy utilization in the United States. Dis Colon Rectum 58:950–956

    Article  PubMed  Google Scholar 

  13. Staudacher C, Vignali A (2010) Laparoscopic surgery for rectal cancer: the state of the art. World J Gastrointest Surg 2:275–282

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fleshman J, Branda M, Sargent DJ 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

    Article  CAS  PubMed  Google Scholar 

  15. Marks G, Mohiuddin M, Rakinic J (1991) New hope and promise for sphincter preservation in the management of cancer of the rectum. Semin Oncol 18:388–398

    CAS  PubMed  Google Scholar 

  16. Marks G, Bannon J, Marks J (1996) Transanal-abdominal Transanal radical proctosigmoidectomy with coloanal anastomosis for distal rectal cancer. In: Baker R, Fisher J, Nyhus L (eds) Mastery of surgery, 3rd edn. Little, Brown and Company Inc, Boston, pp 1524–1534

    Google Scholar 

  17. Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707

    Article  CAS  PubMed  Google Scholar 

  18. Marks JH, Frenkel JL, Greenleaf CE, D’Andrea AP (2014) Transanal endoscopic microsurgery with entrance into the peritoneal cavity: Is it safe? Dis Colon Rectum 57:1176–1182

    Article  PubMed  Google Scholar 

  19. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 56:301–307

    Article  PubMed  Google Scholar 

  20. Marks JH (2009) Transanal proctectomy using TEM endoscope: initial experience. Unpublished raw data

  21. de Lacy AM, Rattner DW, Adelsdorfer C et al (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  PubMed  Google Scholar 

  22. Washington K, Berlin J, Branton P, Cancer Committee, College of American Pathologists et al (2008) Protocol for the examination of specimens from patients with primary carcinomas of the colon and rectum. Arch Pathol Lab Med 132:1182–1193

    PubMed  Google Scholar 

  23. National Comprehensive Cancer Network (2016) NCCN clinical practice guidelines in oncology: rectal cancer. V.1.2016

  24. Glynne-Jones R, Mawdsley S, Novell JR (2006) The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language. Colorectal Dis 8:800–807

    Article  CAS  PubMed  Google Scholar 

  25. Haggar F, Boushey R (2009) Colorectal cancer epidemiology: incidence, mortality, survival and risk factors. Clin Colon Rectal Surg 22:191–197

    Article  PubMed  PubMed Central  Google Scholar 

  26. Onaitis MW, Noone RB, Hartwig M et al (2001) Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience. Ann Surg 233:778–785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Marks GJ, Marks JH, Mohiuddin M, Brady L (1998) Radical sphincter preservation surgery with coloanal anastomosis following high-dose external irradiation for the very low lying rectal cancer. Recent Results Cancer Res 146:161–174

    Article  CAS  PubMed  Google Scholar 

  28. Marks G, Mohiuddin M, Masoni L et al (1992) High-dose preoperative radiation therapy as the key to extending sphincter preservation surgery for cancer of the distal rectum. Surg Oncol Clin N Am 1:71–85

    Google Scholar 

  29. Marks G, Mohiuddin M, Goldstein SD (1988) Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int J Radiat Oncol Biol Phys 15:1065–1068

    Article  CAS  PubMed  Google Scholar 

  30. Mohammed S, Anaya DA, Awad SS, Albo D, Berger DH, Artinyan A (2015) Sphincter preservation rates after radical resection for rectal cancer in the United States veteran population: opportunity for improvement in early disease. Ann Surg Oncol 22:216–223

    Article  PubMed  Google Scholar 

  31. Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35

    Article  CAS  PubMed  Google Scholar 

  32. Buess G, Kipfmuller K, Ibald R et al (1988) Clinical results of transanal endoscopic microsurgery. Surg Endosc 2:245–250

    Article  CAS  PubMed  Google Scholar 

  33. Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205

    Article  PubMed  Google Scholar 

  34. Steele SR, Maykel JA, Champagne BJ, Orangio GR (2014) Complexities in colorectal surgery: decision-making and management. Springer, New York

    Book  Google Scholar 

  35. Zhou X, Su M, Hu K et al (2016) CT pelvimetry and clinicopathological parameters in evaluation of the technical difficulties in performing open rectal surgery for mid-low rectal cancer. Oncol Lett 11:31–38

    PubMed  Google Scholar 

  36. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734

    Article  PubMed  Google Scholar 

  37. Parfitt JR, Driman DK (2007) The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol 60:849–855

    Article  PubMed  Google Scholar 

  38. Marks JH, Valsdottir EB, Rather AA, Nweze IC, Newman DA, Chernick MR (2010) Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum 53:1023–1029

    Article  CAS  PubMed  Google Scholar 

  39. Stevenson AL, Solomon MJ, Lumley JW et 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  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA

    J. H. Marks, G. A. Montenegro, J. F. Salem, M. V. Shields & G. J. Marks

  2. Division of Colorectal Surgery, Saint Louis University Hospital, Saint Louis, MO, USA

    G. A. Montenegro

Authors
  1. J. H. Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. A. Montenegro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. F. Salem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. V. Shields
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. H. Marks.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marks, J.H., Montenegro, G.A., Salem, J.F. et al. Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol 20, 467–473 (2016). https://doi.org/10.1007/s10151-016-1482-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-016-1482-y

Keywords

Search

Navigation