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Salvage TME following TEM: a possible indication for TaTME

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Abstract

Background

Salvage surgery after transanal endoscopic microsurgery (TEM) has shown mixed results. Transanal total mesorectal excision (TaTME) might be advantageous in this population. The aim of this study was to assess the short-term oncologic and operative outcomes of salvage surgery after TEM, comparing TaTME to conventional salavge TME (sTME).

Methods

Consecutive patients treated with salvage surgery after TEM were identified. Patients who underwent TaTME were compared to those who had conventional sTME. The primary outcome was the ability to perform an appropriate oncologic procedure defined by a composite outcome (negative distal margins, negative radial margins and complete or near complete mesorectum specimen).

Results

During the study period, 41 patients had salvage surgery after TEM. Of those, 11 patients had TaTME while 30 patients had sTME. All patients in the TaTME group met the composite outcome of appropriate oncologic procedure compared to 76.7% for the conventional sTME group (p = 0.19). TaTME was associated with significantly higher rates of sphincter preservation (100 vs. 50%, p = 0.01), higher rates of laparoscopic surgery (100 vs. 23.3%, p < 0.001) and lower rates of conversion to open surgery (9.1 vs. 57%, p < 0.001). No difference was found in postoperative morbidity (36.3 vs. 36.7%, p = 0.77).

Conclusions

The present study demonstrates that for patients requiring salvage surgery after TEM, TaTME is associated with significantly higher rates of sphincter-sparing surgery when compared to conventional transabdominal TME while producing adequate short-term oncologic outcomes. Salvage surgery after TEM might be a clear indication for TaTME rather than conventional surgery.

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References

  1. Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B, Mortensen NJ, Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290

    Article  PubMed  CAS  Google Scholar 

  2. Morino M, Allaix ME, Caldart M, Scozzari G, Arezzo A (2011) Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm. Surg Endosc 25:3683–3690

    Article  PubMed  Google Scholar 

  3. Baatrup G, Breum B, Qvist N et al (2009) Transanal endoscopic microsurgery in 143 consecutive patients with rectal adenocarcinoma: results from a Danish multicenter study. Colorectal Dis 11:270–275

    Article  PubMed  CAS  Google Scholar 

  4. Borschitz T, Heintz A, Junginger T (2006) The influence of histopathological criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 49:1492–1506

    Article  PubMed  Google Scholar 

  5. Barendse RM, Dijkgraaf MG, Rolf UR et al (2013) Colorectal surgeons’ learning curve of transanal endoscopic microsurgery. Surg Endosc 27:3591–3602

    Article  PubMed  Google Scholar 

  6. Schiphorst AH, Langenhoff BS, Maring J, Pronk A, Zimmerman DD (2014) Transanal minimally invasive surgery: initial experience and short-term functional results. Dis Colon Rectum 57:927–932

    Article  PubMed  Google Scholar 

  7. Clermontas SHEM, Van Loon YT, Schiphorst AHW et al (2009) Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results. Int J Colorectal Dis 32:1677

    Article  PubMed  CAS  Google Scholar 

  8. Nash GM, Weiser MR, Guillem JG et al (2009) Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum 52:577–582

    Article  PubMed  Google Scholar 

  9. Greenberg JA, Shibata D, Herndon JE 2nd, Steele GD Jr, Mayer R, Bleday R (2008) Local excision of distal rectal cancer: an update of cancer and leukemia group B 8984. Dis Colon Rectum 51:1185–1191

    Article  PubMed  Google Scholar 

  10. Bach SP, Hill J, Monson JR et al; Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290

    Article  PubMed  CAS  Google Scholar 

  11. You YN, Baxter NN, Stewart A, Nelson H (2007) Is the increasing rate of local excision for stage I rectal cancer in the United States justified? A nationwide cohort study from the National Cancer Database. Ann Surg 245:726–733

    Article  PubMed  PubMed Central  Google Scholar 

  12. Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J; Standards Practice Task Force of the American Society of Colon and RectalSurgeons (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 56(5):535–550

    Article  PubMed  CAS  Google Scholar 

  13. National Comprehensive Cancer Network (2016) Rectal cancer (Version 2). https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed 10 Nov 2016

  14. Bach SP, Hill J, Monson JR et al (2009) Association of coloproctology of Great Britain and Ireland transanal endoscopic microsurgery (TEM) Collaboration. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290

    Article  PubMed  CAS  Google Scholar 

  15. Serra Aracil X, Bombardó Juncá J, Mora López L et al (2009) Site of local surgery in adenocarcinoma of the rectum T2N0M0. Cir Esp 85:103–109

    Article  PubMed  Google Scholar 

  16. Baron PL, Enker WE, Zakowski MF, Urmacher C (1995) Immediate vs. salvage resection after local treatment for early rectal cancer. Dis Colon Rectum 38:177–181

    Article  PubMed  CAS  Google Scholar 

  17. Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S (2005) Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48:429–437

    Article  PubMed  Google Scholar 

  18. Lee WY, Lee WS, Yun SH, Shin SH, Chun HK (2007) Decision for salvage treatment after transanal endoscopic microsurgery. Surg Endosc 21:975–979

    Article  PubMed  Google Scholar 

  19. Smith LE, Ko ST, Saclarides T, Caushaj P, Orkin BA, Khanduja KS (1996) Transanal endoscopic microsurgery. Initial registry results. Dis Colon Rectum 39:S79–S84

    Article  PubMed  CAS  Google Scholar 

  20. Floyd ND, Saclarides TJ (2006) Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 49:164–168

    Article  PubMed  Google Scholar 

  21. Borschitz T, Heintz A, Junginger T (2007) Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications. Dis Colon Rectum 50:292–301

    Article  PubMed  Google Scholar 

  22. Piessen G, Cabral C, Benoist S, Penna C, Nordlinger B (2012) Previous transanal full-thickness excision increases the morbidity of radical resection for rectal cancer. Colorectal Dis 14:445–452

    Article  PubMed  CAS  Google Scholar 

  23. Levic K, Bulut O, Hesselfeldt P, Bülow S (2012) The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study. Tech Coloproctol 17:397–403

    Article  PubMed  Google Scholar 

  24. Morino M, Allaix ME, Arolfo S, Arezzo A (2013) Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Surg Endosc 27:3315–3321

    Article  PubMed  Google Scholar 

  25. Cahill RA, Hompes R (2015) Transanal total mesorectal excision. Br J Surg 102:1591–1593

    Article  PubMed  CAS  Google Scholar 

  26. Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61

    Article  PubMed  CAS  Google Scholar 

  27. Atallah S (2014) Transanal minimally invasive surgery for total mesorectal excision. Minim Invasive Ther Allied Technol 23:10–16

    Article  PubMed  Google Scholar 

  28. D’Hoore A, Wolthuis AM, Sands DR, Wexner S (2016) Transanal total mesorectal excision: the work is progressing well. Dis Colon Rectum 59:247–250

    Article  PubMed  Google Scholar 

  29. Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258

    Article  PubMed  CAS  Google Scholar 

  30. Brown C, Raval MJ, Phang PT, Karimuddin AA (2017) The surgical defect after transanal endoscopic microsurgery: open versus closed management. Surg Endosc 31(3):1078–1082

    Article  PubMed  Google Scholar 

  31. 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

    Article  PubMed  CAS  Google Scholar 

  32. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR, 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Bipat S, Glas AS, Slors FJ et al (2004) Rectal cancer: LOCAL staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783

    Article  PubMed  Google Scholar 

  34. Doornebosch PG, Bronkhorst PJB, Hop WCJ, Bode WA, Sing AK, de Graaf EJR (2008) The role of ERUS in therapeutic decision-making for local vs. transabdominal resection of rectal tumours. Dis Colon Rectum 51:38–42

    Article  PubMed  CAS  Google Scholar 

  35. Marusch F, Ptok H, Sahm M, Schmidt U, Ridwelski K, Gastinger I, Lippert H (2011) Endorectal ultrasound in rectal carcinoma—do the literature results really correspond to the realities of routine clinical care? Endoscopy 43:425–431

    Article  PubMed  CAS  Google Scholar 

  36. Ashraf S, Hompes R, Slater A, Lindsey I, Bach S, Mortensen N, Cunningham C, Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration (2012) A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer. Colorectal Dis 14:821–826

    Article  PubMed  CAS  Google Scholar 

  37. Nivatvongs S, Nicholson JS, Rothenberger DA, Balcos EG, Christenson CE, Nemer FD, Schottler JL, Goldberg SM (1980) Villous adenomas of the rectum: the accuracy of clinical assessment. Surgery 87:549–551

    PubMed  CAS  Google Scholar 

  38. Galandiuk S, Fazio VW, Jagelman DG, Lavery IC, Weakley FA, Petras RE, Badhwar K, McGonagle B, Eastin K, Sutton T (1987) Villous and tubulovillous adenomas of the colon and rectum. A retrospective review, 1964–1985. Am J Surg 153:41–47

    Article  PubMed  CAS  Google Scholar 

  39. Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume JC, Faivre J (2003) Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 46:1345–1350

    Article  PubMed  Google Scholar 

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Correspondence to C. J. Brown.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committtee and with the 1964 Helsinki Declaration and its later amendments.

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Letarte, F., Raval, M., Karimuddin, A. et al. Salvage TME following TEM: a possible indication for TaTME. Tech Coloproctol 22, 355–361 (2018). https://doi.org/10.1007/s10151-018-1784-3

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  • DOI: https://doi.org/10.1007/s10151-018-1784-3

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