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Multicenter Study
. 2025 Feb;39(2):970-977.
doi: 10.1007/s00464-024-11390-w. Epub 2024 Dec 11.

Oncologic safety and technical feasibility of completion transanal total mesorectal excision after local excision; a cohort study from the International TaTME Registry

Siem A Dingemans #  1 , Saskia I Kreisel #  1   2 , Marieke L W Rutgers  1 , Gijsbert D Musters  3 , Roel Hompes  1   2 , Carl J Brown  4   5 ; International TaTME Registry Collaborative
Collaborators, Affiliations
Multicenter Study

Oncologic safety and technical feasibility of completion transanal total mesorectal excision after local excision; a cohort study from the International TaTME Registry

Siem A Dingemans et al. Surg Endosc. 2025 Feb.

Abstract

Background: As part of an organ sparing strategy, a surgical local excision may be performed in patients with early-stage rectal cancer or following neoadjuvant (chemo)radiotherapy. In selected cases, a completion total mesorectal excision may be recommended which can be more complex because of the preceding local excision. A transanal approach to perform completion total mesorectal excision may offer an advantage through the better visualization of the surgical field in the distal rectum and less forceful retraction for exposure. However, the oncologic safety and technical feasibility of this approach have yet to be demonstrated in these patients. Therefore, the aim of this study was to evaluate the oncological and technical safety of completion transanal total mesorectal excision following a local excision in patients with rectal cancer.

Methods: Patients from the prospective International Transanal Total Mesorectal Excision Registry who underwent a surgical local excision prior to completion transanal total mesorectal excision were retrospectively analyzed.

Results: In total, 189 patients were included of which 22% received neoadjuvant radiotherapy. In 94% of the patients, a low anterior resection was performed. A primary anastomosis was constructed in 91% (n = 171/189) of the patients, with the majority also receiving a defunctioning stoma (84%, n = 144/171), of which 69% (n = 100/144) were reversed. Within 30 days, 7% developed an anastomotic leakage. The two-year local recurrence rate was 5% (n = 5/104) with an estimated rate of 3% (95% CI 0-7%). Two-year disease-free survival was 85% (n = 88/104) and overall survival was 95% (n = 99/104).

Conclusions: Transanal completion total mesorectal excision following local excision for rectal cancer is oncologically safe, with low complication rates and high restorative rates.

Keywords: Completion transanal total mesorectal excision; Gastrointestinal restorative surgery; Laparoscopy; Rectal cancer; Transanal.

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Conflict of interest statement

Declarations. Disclosure: Dr. Roel Hompes receives consultancy fees from Applied Medical. Prof. Dr. Carl J. Brown received speaker honoraria from Ethicon for educational event and works with Evidence Based Reviews in Surgery (ebrs.online) that receives educational funding from Medtronic. Dr. Siem A. Dingemans, Dr. Saskia I. Kreisel, Dr. Marieke L.W. Rutgers and Dr. Gijsbert D. Musters have no conflicts of interest or financial ties to disclose. Ethical approval: Ethical approval for the TaTME Registry and publication of its results was obtained from the UK Health Research Authority and Research Ethics Committee (REC reference 15/LO/0499, IRAS project ID 156930).

References

    1. Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. The Lancet. https://doi.org/10.1016/S0140-6736(86)91510-2 - DOI
    1. Koedam TWA et al (2019) Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis. Surg Endosc 33:103 - PubMed
    1. Weiser MR et al (2005) Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum 48(6):1169–1175 - PubMed
    1. Koedam TWA et al (2019) Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis. Surg Endosc 33(1):103–109 - PubMed
    1. Eid Y, Alves A, Lubrano J, Menahem B (2018) Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature. J Visceral Surg. 155:445–452

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