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Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature

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Abstract

Purpose

The present study aimed to compare the operative and oncologic results of transanal total mesorectum excision (Ta-TME) (“down-to-up”) vs. laparoscopic TME (L-TME, “up-to-down”) for low rectal cancer. Additionally, a systematic review of the literature was performed to assess the quality of the current body of evidence on Ta-TME.

Methods

The study population included 32 consecutive patients who underwent Ta-TME between January 2011 and December 2014 that were compared with a matched group of patients undergoing L-TME between January 2008 and December 2010. The literature search was performed following the PRISMA guidelines for a systematic review.

Results

Ta-TME was associated with significantly shorter operative time (195 vs. 225 min; p = 0.017) and hospital stay (7.8 vs. 9.7 days; p = 0.018) compared to L-TME. No group differences were observed for intra-/postoperative complications and oncologic outcomes. One patient in the Ta-TME and two patients in the L-TME group developed local recurrence. The estimated survival rate at 2 years was 95.5 % for the Ta-TME and 96.6 % for the L-TME group (p = 0.646).

The literature search identified 22 relevant retrospective studies on 423 patients operated on Ta-TME or robotic-assisted transanal TME for rectal cancer. The only two comparative studies found similar short-term oncologic outcomes between Ta-TME and L-TME. A complete mesorectum was observed in 85 % of Ta-TME cases. The conversion rate was estimated at 4.3 % and the postoperative complication rate at 30.4 %.

Conclusions

Ta-TME appears to be safe and feasible. It may find special application in patients with anatomic constraints that could make L-TME highly challenging.

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Acknowledgments

The authors would like to thank M. Clotilde Carra, PhD, for her valuable support in the statistical analysis and preparation of the manuscript.

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Authors and Affiliations

  1. Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est—UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France

    Nicola de’Angelis, Daniel Azoulay & Francesco Brunetti

  2. General Surgery Department, University of Eastern Piedmont, A. O. U. “Maggiore della Carità” Hospital, Novara, Italy

    Luca Portigliotti

Authors
  1. Nicola de’Angelis
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  2. Luca Portigliotti
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  3. Daniel Azoulay
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Correspondence to Nicola de’Angelis.

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Funding

Nil

Conflicts of interest

N. de’Angelis declares that he has no conflict of interest. L. Portigliotti declares that he has no conflict of interest. D. Azoulay declares that he has no conflict of interest. F. Brunetti declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Authorship

Study conception and design: Nicola de’Angelis and Luca Portigliotti

Data acquisition: Luca Portigliotti and Nicola de’Angelis

Data analysis and interpretation: Nicola de’Angelis, Luca Portigliotti, Francesco Brunetti

Manuscript drafting: Nicola de’Angelis, Luca Portigliotti, Daniel Azoulay, Francesco Brunetti

Manuscript critical revision: Nicola de’Angelis, Luca Portigliotti, Daniel Azoulay, Francesco Brunetti

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de’Angelis, N., Portigliotti, L., Azoulay, D. et al. Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbecks Arch Surg 400, 945–959 (2015). https://doi.org/10.1007/s00423-015-1350-7

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  • DOI: https://doi.org/10.1007/s00423-015-1350-7

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