Transanal Total Mesorectal Excision for Malignant Rectal Lesion: A Prospective Cohort Study

Mohamed Yehia Elbarmelgi; Haitham Basiouny; Ahmed Khalifa

doi:10.3889/oamjms.2022.7962

Authors

Mohamed Yehia Elbarmelgi Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
Haitham Basiouny Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
Ahmed Khalifa Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.7962

Keywords:

Cancer rectum, Cost, Transanal resection

Abstract

AIMS: The main outcome of this study was to use the transanal total mesorectal excision (TaTME) technique for rectal cancer resection and to assess as a primary endpoint the short-term oncological outcome; in terms of circumferential resection margin, longitudinal resection margins (proximally and distally), and lymph nodes (LN) retrieval, while secondary endpoints were operative time, estimated blood loss, length of hospital stay, cost per case, and overall complication rate.

METHODS: This was a prospective cohort study. Forty patients were included and subjected to TaTME from May 2018 to January 2020 and patients were followed up for a period of 6 months.

RESULTS: Primary endpoint: Depending on the post-operative specimen pathological assessment; circumferential resection margin (CRM) was free in all patients, proximal resection margins had a mean 14.37 2.87 cm, distal resection margins had a mean 2.08 ± 0.4 cm and LNs retrieval had a mean 13.27 ± 5.9, and number of positive LNs had a mean 2.40 ± 3.77. Secondary endpoints: Mean total operative time (from induction of anesthesia till skin closure) was 179.10, estimated blood loss (using gauze visual analog plus what was obtained in the OR suction device) was 133.67 66.59 ml, the length of hospital stay (admission till discharge) was 5.27 ± 1.08 days, cost per case had a mean (in 1000 USD) 2.95 ± 0.12, and overall complication rate was 10%.

CONCLUSION: TaTME represents a promising complementary technique to laparoscopic TME in the step of low rectal dissection.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Silberfein EJ, Chang GJ, You YQ. Cancer of the colon, rectum, and anus. In: Feig BW, Ching CD, editors. MD Anderson Surgical Oncology Handbook. 5th ed., Ch. 11. United States: Lippincott Williams and Wilkins; 2012. p. 347-415.

Heald RJ, Moran BJ, Brown G, Daniels IR. Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia. Br J Surg. 2004;91(1):121-3. https://doi.org/10.1002/bjs.4386 PMid:14716805

van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al, Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomized controlled TME trial. Lancet Oncol. 2011;12:575-82. https://doi.org/10.1016/S1470-2045(11)70097-3 PMid:21596621

Emhoff IA, Lee GC, Sylla P. Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES). Dig Endosc. 2014;26(1):29-42. https://doi.org/10.1111/den.12157 PMid:24033375

Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: Evidence to learn and adopt the technique. Ann Surg. 2015;261:234-6. https://doi.org/10.1097/SLA.0000000000000886 PMid:25565121

Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg. 2008;247(4):642-9. https://doi.org/10.1097/SLA.0b013e3181612c6a PMid:18362627

Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): Survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767-74. https://doi.org/10.1016/S1470-2045(14)70205-0 PMid:24837215

Oh SJ, Shin JY. Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer. J Korean Surg Soc. 2012;82(3):165-71. https://doi.org/10.4174/jkss.2012.82.3.165 PMid:22403750

Wexner SD. Reaching a consensus for the stapled transanal rectal resection procedure. Dis Colon Rectum 2015;58:821.

Zorron R, Phillips HN, Wynn G, Neto MP, Coelho D, Vassallo RC. Down-to-Up transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients. J Minim Access Surg. 2014;10:144-50. https://doi.org/10.4103/0972-9941.134878 PMid:25013331

Algadiem EA, Aleisa AA, Alsubaie HI, Buhlaiqah NR, Algadeeb JB, Alsneini HA. Blood loss estimation using gauze visual analogue. Trauma Mon. 2016;21(2):e34131. https://doi.org/10.5812/traumamon.34131 PMid:27626017

Chan YH. Biostatistics 102: Quantitative Data-parametric and Non-parametric Tests. Singapore Med J. 2003a;44(8):391-6. PMid:14700417

Chan YH. Biostatistics 103: Qualitative Data-tests of independence. Singapore Med J. 2003b;44(10):498-503. PMid:15024452

Lee GC, Sylla P. Shifting paradigms in minimally invasive surgery: Applications of transanal natural orifice transluminal endoscopic surgery in colorectal surgery. Clin Colon Rectal Surg. 2015;28:181-93. https://doi.org/10.1055/s-0035-1555009 PMid:26491411

Tuech JJ, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G, et al. A step toward NOTES total mesorectal excision for rectal cancer: Endoscopic transanal proctectomy. Ann Surg. 2015;261(2):228-33. https://doi.org/10.1097/SLA.0000000000000994 PMid:25361216

Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, et al. Transanal endoscopic proctectomy: An innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum. 2013;56:408-15. https://doi.org/10.1097/DCR.0b013e3182756fa0 PMid:23478607

Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: Short-and mid-term results. Eur J Surg Oncol. 2015;41(4):478-83 https://doi.org/10.1016/j.ejso.2015.01.009 PMid:25633642

Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): Results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol. 2014;18:473-80. https://doi.org/10.1007/s10151-013-1095-7 PMid:24272607

Buchs NC, Nicholson GA, Yeung T, Mortensen NJ, Cunningham C, Jones OM, et al. Transanal rectal resection: An initial experience of 20 cases. Colorectal Dis. 2016;18:45-50. https://doi.org/10.1111/codi.13227 PMid:26639062

De Rosa M, Rondelli F, Boni M, Ermili F, Bugiantella W, Mariani L, et al. Transanal total mesorectal excision (TaTME): Single-centre early experience in a selected population. Updates Surg. 2018;71(1):157-63. https://doi.org/10.1007/s13304-018-0602-9 PMid:30406934

Chen C, Lai Y, Jiang J, Chu CH, Huang IP, Chen WS, et al. Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: A matched case-control study. Ann Surg Oncol. 2016;23(4):1169-76. https://doi.org/10.1245/s10434-015-4997-y PMid:26597369

Vignali A, Elmore U, Milone M, Rosati R. Transanal total mesorectal excision (TaTME): Current status and future perspectives. Updates Surg. 2019;71(1):29-37. https://doi.org/10.1007/s13304-019-00630-7 PMid:30734896

Noh GT, Ann YS, Cheong C, Han J, Cho MS, Hur H, et al. Impact of anastomotic leakage on long-term oncologic outcome and its related factors in rectal cancer. Medicine. 2016;95:e4367. https://doi.org/10.1097/MD.0000000000004367 PMid:27472726

Neshakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2000;88:400-4. https://doi.org/10.1046/j.1365-2168.2001.01719 PMid:11260107

Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: Is this the future of rectal cancer surgery? Colorectal Dis. 2016;18(1):19-36. https://doi.org/10.1111/codi.13151 PMid:26466751

Deijen CL, Tsai A, Koedam TW, Helbach MV, Sietses C, Lacy AM, et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: A systematic review. Tech Coloproctol. 2016;20:811-24. https://doi.org/10.1007/s10151-016-1545-0 PMid:27853973

De Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “Down-to-up” total mesorectal excision (TME)-short-term outcomes in the first 20 cases. Surg Endosc. 2013;27:3165-72. https://doi.org/10.1007/s00464-013-2872-0 PMid:23519489

Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, et al. Transanal total mesorectal excision in rectal cancer: Short term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261(2):221-7. https://doi.org/10.1097/SLA.0000000000000865 PMid:25185463