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. 2023 Aug 23;4(3):e327.
doi: 10.1097/AS9.0000000000000327. eCollection 2023 Sep.

Completion Total Mesorectal Excision: A Case-Matched Comparison With Primary Resection

Thijs A Burghgraef  1   2 , Marieke L Rutgers  3 , Jeroen W A Leijtens  4 , Jurriaan B Tuyman  5 , Esther C J Consten  1   2 , Roel Hompes  3
Affiliations

Completion Total Mesorectal Excision: A Case-Matched Comparison With Primary Resection

Thijs A Burghgraef et al. Ann Surg Open. .

Abstract

Objectives: The aim of this study was to compare the perioperative and oncological results of completion total mesorectal excision (cTME) versus primary total mesorectal excision (pTME).

Background: Early-stage rectal cancer can be treated by local excision alone, which is associated with less surgical morbidity and improved functional outcomes compared with radical surgery. When high-risk histological features are present, cTME is indicated, with possible worse clinical and oncological outcomes compared to pTME.

Methods: This retrospective cohort study included all patients that underwent TME surgery for rectal cancer performed in 11 centers in the Netherlands between 2015 and 2017. After case-matching, we compared cTME with pTME. The primary outcome was major postoperative morbidity. Secondary outcomes included the rate of restorative procedures and 3-year oncological outcomes.

Results: In total 1069 patients were included, of which 35 underwent cTME. After matching (1:2 ratio), 29 cTME and 58 pTME were analyzed. No differences were found for major morbidity (27.6% vs 19.0%; P = 0.28) and abdominoperineal excision rate (31.0% vs 32.8%; P = 0.85) between cTME and pTME, respectively. Local recurrence (3.4% vs 8.6%; P = 0.43), systemic recurrence (3.4% vs 12.1%; P = 0.25), overall survival (93.1% vs 94.8%; P = 0.71), and disease-free survival (89.7% vs 81.0%; P = 0.43) were comparable between cTME and pTME.

Conclusions: cTME is not associated with higher major morbidity, whereas the abdominoperineal excision rate and 3-year oncological outcomes are similar compared to pTME. Local excision as a diagnostic tool followed by completion surgery for early rectal cancer does not compromise outcomes and should still be considered as the treatment of early-stage rectal cancer.

Keywords: rectal cancer; surgery; total mesorectal excision.

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Figures

FIGURE 1.
FIGURE 1.
Patient flow of included patients. cTME indicates completion total mesorectal excision, HIPEC, hyperthermal intraperitoneal chemotherapy; MIRECA, Minimally Invasive REctal CAncer working group; pTME, primary total mesorectal excision; TME, total mesorectal excision.
FIGURE 2.
FIGURE 2.
Kaplan Meier Curves after 3-year follow-up. A, Local recurrence Kaplan–Meier, (B) systemic recurrence Kaplan–Meier, (C) disease-free survival Kaplan–Meier, (D) overall survival Kaplan–Meier. cTME indicates completion total mesorectal excision; pTME: primary total mesorectal excision.
See this image and copyright information in PMC

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