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Zewde MG, Peyser DK, Yu AT, Bonaccorso A, Moshier E, Alavi K, Goldstone R, Marks JH, Maykel JA, McLemore EC, Sands D, Steele SR, Wexner SD, Whiteford M, Sylla P. Oncologic outcomes following transanal total mesorectal excision: the United States experience. Surg Endosc 2024; 38:3703-3715. [PMID: 38782828 DOI: 10.1007/s00464-024-10896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
AIM The benefits and short-term outcomes of transanal total mesorectal excision (taTME) for rectal cancer have been demonstrated previously, but questions remain regarding the oncologic outcomes following this challenging procedure. The purpose of this study was to analyze the oncologic outcomes following taTME at high-volume centers in the USA. METHODS This was a multicenter, retrospective observational study of 8 tertiary care centers. All consecutive taTME cases for primary rectal cancer performed between 2011 and 2020 were included. Clinical, histopathologic, and oncologic data were analyzed. Primary endpoints were rate of local recurrence, distal recurrence, 3-year disease recurrence, and 3-year overall survival. Secondary endpoints included perioperative complications and TME specimen quality. RESULTS A total of 391 patients were included in the study. The median age was 57 years (IQR: 49, 66), 68% of patients were male, and the median BMI was 27.4 (IQR: 24.1, 31.0). TME specimen was complete or near complete in 94.5% of cases and the rates of positive circumferential radial margin and distal resection margin were 2.0% and 0.3%, respectively. Median follow-up time was 30.7 months as calculated using reverse-KM estimator (CI 28.1-33.8) and there were 9 cases (2.5%) of local recurrence not accounting for competing risk. The 3-year estimated rate of disease recurrence was 19% (CI 15-25%) and the 3-year estimated overall survival was 90% (CI 87-94%). CONCLUSION This large multicenter study confirms the oncologic safety and perioperative benefits of taTME for rectal cancer when performed by experienced surgeons at experienced referral centers.
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Affiliation(s)
- Makda Getachew Zewde
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Daniel K Peyser
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Allen T Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Antoinette Bonaccorso
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Karim Alavi
- Department of Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Robert Goldstone
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - John H Marks
- Department of Surgery, Lankenau Institute for Medical Research, Wynnewood, USA
| | - Justin A Maykel
- Department of Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Elisabeth C McLemore
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
| | - Dana Sands
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Scott R Steele
- Department of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
| | - Steven D Wexner
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Mark Whiteford
- Department of Surgery, Providence Portland Medical Center, Portland, USA
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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Rehné Jensen L, Dohrn N, Seiersen M, Bulut O, Bech-Knudsen F, Erik Jansen J, Gögenur I, Falk Klein M. Long-term outcomes after transanal total mesorectal excision for rectal cancer in Denmark: A prospective multicenter study from the late implementation phase. Surg Oncol 2023; 49:101967. [PMID: 37356316 DOI: 10.1016/j.suronc.2023.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term surgical and oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer during an implementation phase on a national level. METHOD This is a retrospective review of prospectively recorded data. Registration was initiated by the Danish Colorectal Cancer Group in order to assess the quality of care during the implementation of TaTME in Denmark. Data from four centers were pooled for simultaneous analysis. Short-term data was available from a prior study, and long-term data regarding recurrences, chemotherapy, and mortality was collected. RESULTS From August 2016 to April 2019, 115 TaTME procedures were registered. Patients were predominantly male (n = 85, 74%) with mid-rectal (n = 88, 77%) tumors. The overall local recurrence rate was 7.8% (n = 9) of which six patients also had systemic recurrence. Mean long-term follow-up was 59.4 months, and median time to local recurrence was 24.9 months. Local recurrences occurred predominantly among initial implementation cases. The overall mortality rate was 13% (n = 15). Of the 17 patients with recurrence, 35% (n = 6) died and developed either solely distant recurrence (n = 2, 12%) or in combination with local recurrence (n = 4, 24%). CONCLUSION We found acceptable long-term oncological results after TaTME during the implementation phase in Denmark. There was an accumulation of local recurrences in the early phase of the study which emphasizes the importance of thorough training and proctoring when starting the approach.
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Affiliation(s)
- Lasse Rehné Jensen
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark.
| | - Niclas Dohrn
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Michael Seiersen
- Department of Surgery, Zealand University Hospital Koege, Koege, Denmark
| | - Orhan Bulut
- Department of Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Flemming Bech-Knudsen
- Department of Surgery, Colorectal Cancer Centre South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jens Erik Jansen
- Department of Surgery, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - Ismail Gögenur
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital Koege, Koege, Denmark; Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark; Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark
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Ourô S, Ferreira M, Roquete P, Maio R. Transanal versus laparoscopic total mesorectal excision: a comparative study of long-term oncological outcomes. Tech Coloproctol 2022; 26:279-290. [PMID: 35050434 DOI: 10.1007/s10151-022-02570-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transanal total mesorectal excision (TaTME) is the most recent approach developed to improve pelvic dissection in surgery for mid and low rectal tumors. There are still inconsistencies regarding the technique's oncological results. The aim of this study was to analyze clinical and oncological outcomes of the learning curve of TaTME in comparison to laparoscopic TME (lapTME). METHODS Rectal cancer patients who had TaTME and lapTME in two Portuguese colorectal units between March 2016 and December 2018 were eligible. Primary endpoints were 5-year overall survival, disease-free survival, and local recurrence. Secondary endpoints were clinical and pathological outcomes. RESULTS Forty-four patients underwent TaTME (29 men) and 39 lapTME (27 men) with a median age of 69 and 66 (p = 0.093), respectively. No differences were observed concerning baseline characteristics, emphasizing their comparability. In the TaTME group, there were more hand-sewn anastomosis (0 lapTME versus 7 TaTME, p = 0.018) with significantly less distance to the dentate line (40 mm lapTME versus 20 mm TaTME, p = 0.005) and significantly more loop ileostomies performed (28 lapTME versus 41 TaTME, p = 0.001). There were no differences in post-operative mortality, morbidity, readmissions, and stoma closure. Groups were similar in relation to specimen quality, margins, and resectability; however, TaTME had a significantly higher node yield (14 lapTME versus 20 TaTME, p = 0.002). Finally, no disparities were noted in oncological outcomes, namely local and distant recurrence, 5-year overall survival, and disease-free survival. CONCLUSIONS Even with the disadvantage of the learning curve of a new technique, TaTME appears to be comparable to lapTME, with similar long-term oncological outcomes. It has, however, a demanding learning curve, significant risk for morbidity and should be used only for selected patients.
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Affiliation(s)
- S Ourô
- Consultant in General and Colorectal Surgery, Surgical Department of Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
- NOVA Medical School, Lisbon, Portugal.
| | - M Ferreira
- Consultant in General Surgery, Surgical Department of Hospital Beatriz Ângelo, Lisbon, Portugal
| | - P Roquete
- Consultant in General Surgery, Surgical Department of Hospital da Luz, Lisbon, Portugal
| | - R Maio
- Consultant in General Surgery, Head of the Surgical Department of Hospital Beatriz Ângelo, Lisbon, Portugal
- Full Professor of Surgery, NOVA Medical School, Lisbon, Portugal
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