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Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiation therapy (nCRT) has been indicated for locally advanced rectal cancer. While utilization of laparoscopy in rectal cancer surgery has been popular in recent years, tumors receiving nCRT is still a surgical challenge. Transanal total mesorectal excision (TaTME) has emerged as a focused area of laparoscopic surgery that is becoming an increasingly acceptable approach in the field of rectal surgery.

Methods

Between December 2013 and April 2015, a total of 50 patients (38 males) with post-nCRT middle or lower rectal cancer who then underwent TaTME at two separate institutions were prospectively documented. Overall, 100 matched control cohorts who received conventional laparoscopic rectal surgery (LapTME) were simultaneously retrieved from a prospectively registered database. Four parameters of sex, age, clinical stage, and American Society of Anesthesiologists (ASA) score were matched for surgical outcomes, and short-term oncological results, including complications and pathological outcomes, were analyzed.

Results

Both the TaTME and LapTME groups received 5-fluorouracil-based chemotherapy and 5 weeks of long-course radiation therapy. Mean operative time for the TaTME group was 182.1 ± 55.4 min (156.6 ± 37.8 min in two-team-approach cases) and 178.7 ± 34.8 min for the LapTME group. The TaTME group yielded longer distal margin lengths. No significant differences were observed in blood loss, intraoperative complication rate, conversion rate, anastomosis type, and free circumferential margin rate.

Conclusion

This matched case–control study demonstrated that TaTME is safe and feasible. Compared with LapTME, TaTME not only achieves identical circumferential margin status without compromising other operative and quality parameters but also benefits patients by achieving a longer distal margin. Thus, TaTME has the potential to become an option in managing irradiated rectal cancer.

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Disclosures

Drs. Chien-Chih Chen, Yi-Ling Lai, Jeng-Kae Jiang, Chun-Ho Chu, I-Ping Huang, Wei-Shone Chen, Shung-Haur Yang, and Andy Yi-Ming Cheng have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Chien-Chih Chen MD, Yi-Ling Lai MD, Chun-Ho Chu MD & I-Ping Huang MD

  2. College of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chien-Chih Chen MD, Jeng-Kae Jiang MD, PhD, Chun-Ho Chu MD, Wei-Shone Chen MD, PhD & Shung-Haur Yang MD, PhD

  3. Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Jeng-Kae Jiang MD, PhD, Wei-Shone Chen MD, PhD & Shung-Haur Yang MD, PhD

  4. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Andy Yi-Ming Cheng MD

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  1. Chien-Chih Chen MD
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  2. Yi-Ling Lai MD
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Correspondence to Shung-Haur Yang MD, PhD.

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Chen, CC., Lai, YL., Jiang, JK. et al. Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study. Ann Surg Oncol 23, 1169–1176 (2016). https://doi.org/10.1245/s10434-015-4997-y

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  • DOI: https://doi.org/10.1245/s10434-015-4997-y

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