Impact of Two-Team Surgery on Short- and Long-Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer

Minimally invasive total mesorectal excision is widely used in rectal cancer surgery because of its better surgical field-of-view and recognition of microanatomy, compared with open surgery; however, it remains difficult to perform deep pelvic manipulation. Transanal total mesorectal excision (TaTME) is expected to overcome these difficulties, especially in two-team surgeries with simultaneous abdominal and transanal approaches.

Data were collected from patients with rectal cancer who underwent TaTME between January 2012 and December 2019 at 26 specialized rectal cancer institutions in Japan. Patients in the two-team surgery group were propensity score-matched in a 2:1 ratio to those in the one-team surgery group. Surgical outcomes, postoperative complications, transanal approach-related outcomes, and survival rates were compared between the two surgical groups.

Overall, 444 patients (296 and 148 in the two- and one-team surgery groups, respectively) were included in the analyses. The median operation time was significantly shorter (p < 0.001), the median estimated blood loss (p < 0.001) and positive distal margin rates (p = 0.020) were significantly lower, the number of lymph nodes dissected was significantly higher (p = 0.011) in the two-team surgery group versus the one-team surgery group. The two groups did not differ in postoperative complications. The 5-year relapse-free survival rate was slightly higher in the two-team surgery group than in the one-team surgery group, although there was not statistically significant (p = 0.244).

Two-team surgery has advantages of shorter operation time, decreased estimated blood loss, increased number of lymph nodes dissected and decreased positive distal margin rates and potential to decrease recurrence rates.