Transanal total mesorectal excision for locally advanced middle–low rectal cancers. Issue 2 (23rd November 2019)

• Record Type: Journal Article
• Authors: Thien, H H; Hiep, P N; Thanh, P H; Xuan, N T; Trung, T N; Vy, P T; Dong, P X; Hieu, M T; Son, N H
• Is Part Of: BJS open. Volume 4:Issue 2(2020)
• Page Start: 268
• Page End: 273
• Publication Date: 2019-11-23
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50234
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer. Methods: Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short-term survival and functional outcomes, were analysed. Results: Thirty-eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m 2 . Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand-sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. Conclusion: Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity. Graphical Abstract: A prospective study was undertaken of 38 patients with mid–low locally advanced rectal cancer who underwent rectal resection with transanal total mesorectal excision (TaTME) procedure. No conversions, abdominoperineal resections or deaths occurred. TaTME is safe and effective for patients with mid–low locally advanced rectal cancer. TaTME and rectal cancer