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Comparative Study
. 2020 Jul 20;20(1):677.
doi: 10.1186/s12885-020-07171-y.

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis

F B de Lacy  1 , S X Roodbeen  2 , J Ríos  3 , J van Laarhoven  4 , A Otero-Piñeiro  5 , R Bravo  5 , T Visser  6 , R van Poppel  6 , S Valverde  5 , R Hompes  2 , C Sietses  6 , A Castells  7 , W A Bemelman  2 , P J Tanis  2 , A M Lacy  5
Affiliations
Comparative Study

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis

F B de Lacy et al. BMC Cancer. .

Abstract

Background: For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME).

Methods: Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence.

Results: A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1-6.1) in the TaTME group and 9.6% (95% CI, 6.5-12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23-0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8-79.8) and 68.6% (95% CI, 63.7-73.5) (HR = 0.82; 95% CI, 0.65-1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7-91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53-1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62-0.98; p = 0.033).

Conclusions: These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.

Keywords: Locoregional recurrence; Rectal cancer; TaTME; Total mesorectal excision.

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Conflict of interest statement

Dr. F. Borja de Lacy, Drs. Sapho Xenia Roodbeen, Mr. Jose Ríos, Dr. Jacqueline van Laarhoven, Dr. Ana Otero-Piñeiro, Dr. Raquel Bravo, Dr. Tjaakje Visser, Dr. Roy van Poppel, and Dr. Silvia Valverde have no conflicts of interest or financial ties to disclose. Dr. Roel Hompes reports an educational grant from Stryker, personal fees from Applied Medical outside the submitted work. Dr. Colin Sietses reports personal fees from Medtronic, personal fees from Olympus, and personal fees from AFS medical, outside the submitted work. Dr. Antoni Castells reports personal fees from Amadix, Goodgut and Universal Diagnostics, and grants from SAF2014 and AECC, outside the submitted work. Dr. Willem A. Bemelman reports grants from VIFOR, grants from Medtronic, and grants from Braun, outside the submitted work. Dr. Pieter J. Tanis reports personal fees from Johnson & Johnson, personal fees from Olympus, and personal fees from B Braun, and research grant from Life Cell, outside the submitted work. Dr. Antonio M. Lacy reports personal fees from Medtronic, personal fees from Olympus, personal fees from Applied Medical, and personal fees from Conmed, outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow diagram of study population. Abbreviations: TME, total mesorectal excision; AMC, Amsterdam University Medical Centers; ASA, American Society of Anesthesiologists; BMI, body mass index; CRM, circumferential resection margin; NAT, neoadjuvant therapy; LapTME, laparoscopic total mesorectal excision; TaTME, transanal total mesorectal excision
Fig. 2
Fig. 2
Three-year locoregional recurrence between TaTME and LapTME in patients with locally advanced rectal cancer. Abbreviations: TaTME, transanal total mesorectal excision; LapTME, laparoscopic total mesorectal excision; HR, hazard ratio; CI, confidence interval
Fig. 3
Fig. 3
Three-year disease-free survival between TaTME and LapTME in patients with locally advanced rectal cancer. Abbreviations: TaTME, transanal total mesorectal excision; LapTME, laparoscopic total mesorectal excision; HR, hazard ratio; CI, confidence interval
Fig. 4
Fig. 4
Subgroup analyses of survival and recurrence among patients with locally advanced rectal cancer treated with TaTME or LapTME. Abbreviations: HR, hazard ratio; CI, confidence interval; APR, abdominoperineal resection; TaTME, transanal total mesorectal excision; LapTME, laparoscopic total mesorectal excision
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