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Transanal versus conventional total mesorectal excision for rectal cancer using the IDEAL framework for

R L Robertson1, A Karimuddin1, T Phang1

  • 1Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

BJS Open
|April 23, 2021
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Summary

Transanal total mesorectal excision (TaTME) offers comparable outcomes to conventional total mesorectal excision (cTME) for rectal cancer. This study found no significant differences in pathological quality, morbidity, or survival rates between the two surgical techniques.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Minimally Invasive Procedures

Background:

  • Transanal total mesorectal excision (TaTME) is an emerging technique for distal rectal cancer.
  • Concerns exist regarding potential increases in morbidity and local recurrence rates compared to conventional approaches.
  • This study aimed to evaluate the outcomes of TaTME against conventional total mesorectal excision (cTME).

Purpose of the Study:

  • To compare the pathological outcomes, short-term clinical results, and survival rates of TaTME versus cTME in rectal cancer patients.
  • To assess the safety and efficacy of TaTME when implemented using IDEAL principles.

Main Methods:

  • A retrospective review was conducted comparing TaTME cases with a propensity-matched cohort of cTME cases from a single institution.
  • Data were collected on pathological outcomes (margin status, TME quality), morbidity (including anastomotic leaks), and survival rates.
  • Propensity score matching was used to create comparable groups for analysis.

Main Results:

  • Nine patients (8.3%) in the TaTME group and 11 (10.5%) in the cTME group had positive margins or incomplete TME (P=0.65).
  • No significant differences in morbidity or anastomotic leak rates were observed between TaTME and cTME groups.
  • Estimated 3-year local recurrence-free, overall, and disease-free survival rates were similar for both techniques.

Conclusions:

  • Transanal total mesorectal excision (TaTME) demonstrates comparable pathological and short-term clinical outcomes to conventional total mesorectal excision (cTME) for rectal cancer.
  • The application of IDEAL principles in TaTME implementation is associated with similar results to cTME.
  • TaTME is a viable alternative to cTME for rectal cancer treatment, with comparable safety and efficacy profiles.