Comparison of transanal versus laparoscopic total mesorectal excision in low rectal cancer

Document Type: Research/Original Article

Authors

1 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Community Medicine Specialist, Emergency Medicine Department, Shiraz University of Medical Science, Shiraz, Iran

3 General Surgery Resident, Department of General Surgery, Shiraz University of Medical Science, Shiraz, Iran

Abstract

Background: Transanal Total Mesorectal Excision (TaTME) presented in recent years as a novel technique to achieve better outcome in circumferential margin (CRM) and distal margin (DRM) in lower rectal cancer operation. The current study aimed to assess the perioperative and pathological characteristics of TaTME in comparison with laparoscopic total mesorectal excision (LaTME) in patients with mid- and low-rectal cancer.
Methods: From January 2016 to December 2018, we enrolled all consecutive patients with rectal cancer, who underwent TaTME and LaTME. Primary endpoints like circumferential rectal margin (CRM) status, distal rectal margin (DRM) status, and pathological outcomes, as well as secondary endpoints including perioperative outcomes (total blood loss, duration of hospitalization, anastomosis leakage, as well as 30-day mortality) were evaluated and compared statistically (α=0.05).
Results: 11 patients with distal rectal adenocarcinoma which was biopsy-proven, underwent TaTME, and 19 patients operated on using LaTME. Both groups were similar in the baseline characteristics. Also, the perioperative outcomes were similar in both groups. Regarding pathological outcomes, no patients with CRM Conclusion: TaTME is a reasonable procedure in patients with low rectal cancer. But no remarkable superiority was observed in this method compared to laparoscopy with respect to the pathological outcomes.

Keywords


1.            Koedam TW, van Ramshorst GH, Deijen CL, Elfrink AK, Meijerink WJ, Bonjer HJ, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Techniques in coloproctology. 2017;21(1):25-33.
2.            Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. The American journal of surgical pathology. 2002;26(3):350-7.
3.            Buchs NC, Nicholson GA, Yeung T, Mortensen NJ, Cunningham C, Jones OM, et al. Transanal rectal resection: an initial experience of 20 cases. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016;18(1):45-50.
4.            Rubinkiewicz M, Czerwińska A, Zarzycki P, Małczak P, Nowakowski M, Major P, et al. Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis. Journal of clinical medicine. 2018;7(11).
5.            Perdawood SK, Al Khefagie GA. Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016;18(1):51-8.
6.            Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016;18(1):19-36.
7.            Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, et al. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. Journal of the American College of Surgeons. 2015;221(2):415-23.
8.            Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surgical endoscopy. 2010;24(5):1205-10.
9.            Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg. 2014;260(6):993-9.
10.          Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2015;41(4):478-83.
11.          Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg. 2017;266(1):111-7.
12.          Gosens MJ, Klaassen RA, Tan-Go I, Rutten HJ, Martijn H, van den Brule AJ, et al. Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clinical cancer research : an official journal of the American Association for Cancer Research. 2007;13(22 Pt 1):6617-23.
13.          Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C. Low rectal cancer: classification and standardization of surgery. Diseases of the colon and rectum. 2013;56(5):560-7.
14.          Pisarska M, Pędziwiatr M, Małczak P, Major P, Ochenduszko S, Zub-Pokrowiecka A, et al. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. International journal of surgery (London, England). 2016;36(Pt A):377-82.
15.          Suwanabol PA, Maykel JA. Transanal Total Mesorectal Excision: A Novel Approach to Rectal Surgery. Clinics in colon and rectal surgery. 2017;30(2):120-9.
16.          Sobin LH, Fleming ID. TNM Classification of Malignant Tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer. 1997;80(9):1803-4.
17.          Bonjer HJ, Deijen CL, Haglind E. A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer. The New England journal of medicine. 2015;373(2):194.
18.          Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. 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. 2015;314(13):1346-55.
19.          Sung S, Kim SH, Lee JH, Nam TK, Jeong S, Jang HS, et al. Continuous Effect of Radial Resection Margin on Recurrence and Survival in Rectal Cancer Patients Who Receive Preoperative Chemoradiation and Curative Surgery: A Multicenter Retrospective Analysis. International journal of radiation oncology, biology, physics. 2017;98(3):647-53.
20.          Funahashi K, Koike J, Teramoto T, Saito N, Shiokawa H, Kurihara A, et al. Transanal rectal dissection: a procedure to assist achievement of laparoscopic total mesorectal excision for bulky tumor in the narrow pelvis. American journal of surgery. 2009;197(4):e46-50.
21.          Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(2):303-12.
22.          Hu D, Jin P, Hu L, Liu W, Zhang W, Guo T, et al. The application of transanal total mesorectal excision for patients with middle and low rectal cancer: A systematic review and meta-analysis. Medicine. 2018;97(28):e11410.
23.          Jiang HP, Li YS, Wang B, Wang C, Liu F, Shen ZL, et al. Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis. Surgical endoscopy. 2018;32(6):2632-42.
24.          Shirouzu K, Ogata Y, Araki Y. Oncologic and functional results of total mesorectal excision and autonomic nerve-preserving operation for advanced lower rectal cancer. Diseases of the colon and rectum. 2004;47(9):1442-7.
25.          Sohn DK, Park SC, Kim MJ, Chang HJ, Han KS, Oh JH. Feasibility of transanal total mesorectal excision in cases with challenging patient and tumor characteristics. Annals of surgical treatment and research. 2019;96(3):123-30.
26.          Veltcamp Helbach M, Koedam TWA, Knol JJ, Diederik A, Spaargaren GJ, Bonjer HJ, et al. Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancer. Surgical endoscopy. 2019;33(1):94-102.
27.          Chang TC, Kiu KT. Transanal Total Mesorectal Excision in Lower Rectal Cancer: Comparison of Short-Term Outcomes with Conventional Laparoscopic Total Mesorectal Excision. Journal of laparoendoscopic & advanced surgical techniques Part A. 2018;28(4):365-9.
28.          Lei P, Ruan Y, Yang X, Fang J, Chen T. Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. International journal of surgery (London, England). 2018;60:113-9.
29.          Trépanier JS, Arroyave MC, Bravo R, Jiménez-Toscano M, DeLacy FB, Fernandez-Hevia M, et al. Transanal Hartmann's colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients. Surgical endoscopy. 2017;31(12):4981-7.
30.          Buunen M, Bonjer HJ, Hop WC, Haglind E, Kurlberg G, Rosenberg J, et al. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Danish medical bulletin. 2009;56(2):89-91.
31.          van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet Oncology. 2013;14(3):210-8.
32.          Chen YT, Kiu KT, Yen MH, Chang TC. Comparison of the short-term outcomes in lower rectal cancer using three different surgical techniques: Transanal total mesorectal excision (TME), laparoscopic TME, and open TME. Asian journal of surgery. 2019;42(6):674-80.