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Salvage TME following TEM: a possible indication for TaTME
F Letarte1, M Raval1, A Karimuddin1
1Department of Colorectal Surgery, St. Paul's Hospital Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Techniques in Coloproctology
|May 5, 2018
Summary
Transanal total mesorectal excision (TaTME) offers improved sphincter preservation and higher laparoscopic rates for salvage surgery after transanal endoscopic microsurgery (TEM). This approach demonstrates effective oncologic outcomes, making it a favorable option compared to conventional methods.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Salvage surgery following transanal endoscopic microsurgery (TEM) presents variable outcomes.
- Transanal total mesorectal excision (TaTME) may offer benefits in this challenging surgical context.
Purpose of the Study:
- To evaluate the short-term oncologic and operative results of salvage surgery after TEM.
- To compare the efficacy of TaTME versus conventional salvage total mesorectal excision (sTME).
Main Methods:
- Retrospective analysis of consecutive patients undergoing salvage surgery post-TEM.
- Comparison of outcomes between patients treated with TaTME and conventional sTME.
- Primary endpoint: achievement of an appropriate oncologic procedure (negative margins, complete mesorectal excision).
Main Results:
- All 11 TaTME patients achieved the oncologic endpoint versus 76.7% of 30 sTME patients (p=0.19).
- TaTME showed significantly higher sphincter preservation (100% vs 50%, p=0.01) and laparoscopic rates (100% vs 23.3%, p<0.001).
- Lower conversion to open surgery rates (9.1% vs 57%) and similar postoperative morbidity were observed.
Conclusions:
- TaTME is associated with superior sphincter preservation and oncologic adequacy in salvage surgery after TEM.
- Transanal total mesorectal excision (TaTME) represents a promising approach for salvage surgery post-TEM.
- Consideration of TaTME is recommended over conventional transabdominal approaches for salvage surgery after TEM.
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