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Oncologic safety and technical feasibility of completion transanal total mesorectal excision after local excision; a cohort study from the International TaTME Registry

  • 期刊论文

  • 发表日期：

    2024年12月11日

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  • Siem A. Dingemans,
  • Saskia I. Kreisel,
  • Marieke L. W. Rutgers,
  • Gijsbert D. Musters,
  • Roel Hompes,
  • Carl J. Brown,
  • Adamina Michel,
  • Aigner Felix,
  • Arnold Steve,
  • Aryal Kamal,
  • Atallah Sam,
  • Bandyopadhyay Dib,
  • Bánky Balázs,
  • Bemelman Willem,
  • Brown Carl,
  • Berti Stefano,
  • Bordeianou Liliana,
  • Cambell Kenneth,
  • Caricato Marco,
  • Christoforidis Dimitri,
  • Dagbert Francois,
  • Delrio Paolo,
  • D.’Hooge Pieter,
  • Doornebosch Pascal,
  • Ezequiel Mattacheo Adrián,
  • Gecim Ethem,
  • Gloeckler Markus,
  • Grolich Tomas,
  • Grosek Jan,
  • Hahnloser Dieter,
  • Haunold Dringrid,
  • Karoty Mark,
  • Killeen Shane,
  • Kneist Werner,
  • Konstantinos Mavrantonis,
  • Korsgen Stephan,
  • Kyung Sohn Dae,
  • Lacy Fortuni Antonio,
  • Lezoche Emanuele,
  • Liberman Sender,
  • Nicol Deborah,
  • Mackey Paul,
  • Maroni Nirvana,
  • McCarthy Kathryn,
  • Merrie Arend,
  • Mikalauskas Saulius,
  • Millán Scheiding Mónica,
  • Miroshnychenko Yevgen,
  • Montroni Isacco,
  • Muratore Andrea,
  • Ochsner Alex,
  • Panis Yves,
  • Pattyn Paul,
  • Pera Miguel,
  • Perez Rodrigo,
  • Pfeffer Frank,
  • Pooter Karl de,
  • Prós Ribas Imma,
  • Rajendran Nirooshun,
  • Seitinger Gerald,
  • Sietses Collin,
  • Sileri Pierpaolo,
  • Simo Fernandez Vicente,
  • Siu Yan Kok Amy,
  • Spinelli Antonio,
  • Struder Peter,
  • Syk Erik,
  • Tuech Jean-Jacques,
  • Tuynman Jurriaan,
  • Vannieuwenhove Yves,
  • Warrier Satish,
  • Wegstapel Henk,
  • Weiss Helmut,
  • Wolthuis Albert,
  • Wynn Greg

摘要

Background

As part of an organ sparing strategy, a surgical local excision may be performed in patients with early-stage rectal cancer or following neoadjuvant (chemo)radiotherapy. In selected cases, a completion total mesorectal excision may be recommended which can be more complex because of the preceding local excision. A transanal approach to perform completion total mesorectal excision may offer an advantage through the better visualization of the surgical field in the distal rectum and less forceful retraction for exposure. However, the oncologic safety and technical feasibility of this approach have yet to be demonstrated in these patients. Therefore, the aim of this study was to evaluate the oncological and technical safety of completion transanal total mesorectal excision following a local excision in patients with rectal cancer.

Methods

Patients from the prospective International Transanal Total Mesorectal Excision Registry who underwent a surgical local excision prior to completion transanal total mesorectal excision were retrospectively analyzed.

Results

In total, 189 patients were included of which 22% received neoadjuvant radiotherapy. In 94% of the patients, a low anterior resection was performed. A primary anastomosis was constructed in 91% (n = 171/189) of the patients, with the majority also receiving a defunctioning stoma (84%, n = 144/171), of which 69% (n = 100/144) were reversed. Within 30 days, 7% developed an anastomotic leakage. The two-year local recurrence rate was 5% (n = 5/104) with an estimated rate of 3% (95% CI 0–7%). Two-year disease-free survival was 85% (n = 88/104) and overall survival was 95% (n = 99/104).

Conclusions

Transanal completion total mesorectal excision following local excision for rectal cancer is oncologically safe, with low complication rates and high restorative rates.