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

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.