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Multicenter Study
. 2019 Jan;33(1):103-109.
doi: 10.1007/s00464-018-6280-3. Epub 2018 Jul 2.

Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis

T W A Koedam  1   2 , M Veltcamp Helbach  3 , M Penna  4 , A Wijsmuller  5 , P Doornebosch  6 , H L van Westreenen  7 , R Hompes  4 , H J Bonjer  5 , C Sietses  3 , E de Graaf  6 , J B Tuynman  5
Affiliations
Multicenter Study

Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis

T W A Koedam et al. Surg Endosc. 2019 Jan.

Abstract

Background: Local excision of early rectal tumors as a rectal preserving treatment is gaining popularity, especially since bowel cancer screening programs result in a shift towards the diagnosis of early stage rectal cancers. However, unfavorable histological features predicting high risk for recurrence within the "big biopsy" may mandate completion total mesorectal excision (cTME). Completion surgery is associated with higher morbidity, poorer specimen quality, and less favorable oncological outcomes compared to primary TME. Transanal approach potentially improves outcome of completion surgery for rectal cancer. The aim of this study was to compare radical completion surgery after local excision for rectal cancer by the transanal approach (cTaTME) with conventional abdominal approach (cTME).

Methods: All consecutive patients who underwent cTaTME for rectal cancer between 2012 and 2017 were case-matched with cTME patients, according to gender, tumor height, preoperative radiotherapy, and tumor stage. Surgical, pathological, and short-term postoperative outcomes were evaluated.

Results: In total, 25 patients underwent completion TaTME and were matched with 25 patients after cTME. Median time from local excision to completion surgery was 9 weeks in both groups. In the cTaTME and cTME groups, perforation of the rectum occurred in 4 and 28% of patients, respectively (p = 0.049), leading to poor specimen quality in these patients. Number of harvested lymph nodes was higher after cTaTME (median 15; range 7-47) than after cTME (median 10; range 0-17). No significant difference was found in end colostomy rate between the two groups. Major 30-day morbidity (Clavien-Dindo≥ III) was 20 and 32%, respectively (p = 0.321). Hospital stay was significantly longer after cTME.

Conclusion: TaTME after full-thickness excision is a promising technique with a significantly lower risk of perforation of the rectum and better specimen quality compared to conventional completion TME.

Keywords: Completion; Outcomes; Rectal surgery; TAMIS; TaTME.

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Conflict of interest statement

Dr. J. Tuynman reports grants from Dutch Cancer Society and personal fees from Applied Medical outside the submitted work. Dr. C. Sietses reports grants from Olympus and Applied Medical during the conduct of the study and personal fees from Medtronic and Applied Medical outside the submitted work. Dr. R. Hompes reports personal fees from Applied Medical outside the submitted work. Dr. J. Bonjer reports grants from Stryker, Medtronic, Applied Medical, grants and personal fees from Olympus and Ethicon Endosurgery outside the submitted work. Drs. T. Koedam, drs M. Veltcamp Helbach, drs. M. Penna dr. A. Wijsmuller, dr. van Westreenen, dr. E. de Graaf, and dr. P. Doornebosch have no conflicts of interest or financial ties to disclose.

References

    1. Hompes R, McDonald R, Buskens C, et al. Completion surgery following transanal endoscopic microsurgery: assessment of quality and short- and long-term outcome. Colorectal Dis. 2013;15:576–581. doi: 10.1111/codi.12381. - DOI - PubMed
    1. Levic K, Bulut O, Hesselfeldt P, et al. The outcome of rectal cancer after early salvage TME following TAMIS compared with primary TME: a case-matched study. Tech Coloproctol. 2013;17:397–403. doi: 10.1007/s10151-012-0950-2. - DOI - PubMed
    1. Van Gijn W, Brehm V, de graaf E, et al. Unexpected rectal cancer after TAMIS: outcome of completion surgery compared with primary TME. Eur J Surg Oncol. 2013;39:1225–1229. doi: 10.1016/j.ejso.2013.08.003. - DOI - PubMed
    1. Morino M, Allaix ME, Arolfo S, et al. Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Surg Endosc. 2013;27:3315–3321. doi: 10.1007/s00464-013-2911-x. - DOI - PubMed
    1. Platell C. Transanal endoscopic microsurgery. ANZ J Surg. 2009;79:275–280. doi: 10.1111/j.1445-2197.2009.04859.x. - DOI - PubMed

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