Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark

Abstract

Aim: Laparoscopic total mesorectal excision (LaTME) has improved short-term outcomes of rectal cancer surgery with comparable oncological results to open approach. LaTME can be difficult in the lowermost part of the rectum, leading potentially to higher rates of complications, conversion to open surgery and probably suboptimal oncological quality. Transanal TME (TaTME) can potentially solve these problems. The aim of this study was to compare the short-term results after TaTME with those after LaTME.

Method: A prospectively collected database of consecutive patients who underwent TaTME was maintained. Results were compared with those who underwent LaTME in the preceding period. Patients who underwent low anterior resection or intersphincteric abdominoperineal excision were included. Primary end-points were radical resection and specimen quality. Secondary end-points were complications, rates of conversion, operating time and hospital stay.

Results: In total, 50 patients were included (TaTME = 25, LaTME = 25). The groups were comparative in demographic data and tumour characteristics. Circumferential resection margin was positive in one patient in the TaTME group vs four patients in the LaTME group (P = 0.349). All patients in the TaTME group had either complete or nearly complete specimen quality, while four patients in the LaTME group had incomplete specimen quality (P = 0.113). Less blood loss, shorter operating time and shorter hospital stay were found in the TaTME group (P values 0.016, 0.002 and 0.020 respectively). Intra-operative complications were comparable (P = 0.286).

Conclusion: The TaTME procedure had comparable pathological results and acceptable short-term postoperative outcomes compared to LaTME.

Keywords: TaTME; Transanal TME; rectal cancer; surgery.