Quentin Denost1,2, Paula Loughlin3,4, Remy Chevalier3,4, Bertrand Celerier3,4, Romain Didailler3,4, Eric Rullier3,4. 1. Department of Colorectal Surgery, Centre Medico-chirurgical Magellan, CHU de Bordeaux, 33604, Pessac, France. quentin.denost@chu-bordeaux.fr. 2. Université Bordeaux Segalen, 33076, Bordeaux, France. quentin.denost@chu-bordeaux.fr. 3. Department of Colorectal Surgery, Centre Medico-chirurgical Magellan, CHU de Bordeaux, 33604, Pessac, France. 4. Université Bordeaux Segalen, 33076, Bordeaux, France.
Abstract
AIM: The aim of the current study is to report long-term outcomes after transanal low rectal dissection compared with the conventional laparoscopic approach within the context of the Bordeaux' randomized trial. Results from this randomized trial have indicated that transanal approach was more effective than laparoscopic dissection regarding the rate of negative circumferential resection margin (CRM). Despite a high number of publications regarding the transanal approach for TME, there were no long-term data on survival and local recurrence which are now required. METHODS:One hundred patients with low rectal cancer suitable for laparoscopic TME with handsewn coloanal anastomosis were randomized in transanal versus laparoscopic low rectal dissection from 2008 to 2012. The randomization ratio was 1:1. All patients included in the trial were considered for long-term assessment. Local recurrence, overall- and disease-free survival were assessed by Kaplan-Meier and compared with Log-rank test. RESULTS: The follow up was 60.2 months, similar in both group (p = 0.321). Overall, there were no differences of long-term outcomes. There was a significant association between CRM involvement and local recurrence (p = 0.011), however, the 5-year local recurrence rate was 4%, without any significant difference between transanal and laparoscopic dissection: 3% vs. 5%; p = 0.300. The 5-year disease-free survival was 73%: 72% vs. 74; p = 0.351. CONCLUSION: Lower positivity of the circumferential resection margin was reported after transanal low rectal dissection, but it did not translate into a decreased incidence of local recurrence. Further investigations are necessary to demonstrate advantages of this new procedure.
RCT Entities:
AIM: The aim of the current study is to report long-term outcomes after transanal low rectal dissection compared with the conventional laparoscopic approach within the context of the Bordeaux' randomized trial. Results from this randomized trial have indicated that transanal approach was more effective than laparoscopic dissection regarding the rate of negative circumferential resection margin (CRM). Despite a high number of publications regarding the transanal approach for TME, there were no long-term data on survival and local recurrence which are now required. METHODS: One hundred patients with low rectal cancer suitable for laparoscopic TME with handsewn coloanal anastomosis were randomized in transanal versus laparoscopic low rectal dissection from 2008 to 2012. The randomization ratio was 1:1. All patients included in the trial were considered for long-term assessment. Local recurrence, overall- and disease-free survival were assessed by Kaplan-Meier and compared with Log-rank test. RESULTS: The follow up was 60.2 months, similar in both group (p = 0.321). Overall, there were no differences of long-term outcomes. There was a significant association between CRM involvement and local recurrence (p = 0.011), however, the 5-year local recurrence rate was 4%, without any significant difference between transanal and laparoscopic dissection: 3% vs. 5%; p = 0.300. The 5-year disease-free survival was 73%: 72% vs. 74; p = 0.351. CONCLUSION: Lower positivity of the circumferential resection margin was reported after transanal low rectal dissection, but it did not translate into a decreased incidence of local recurrence. Further investigations are necessary to demonstrate advantages of this new procedure.
Authors: María Fernández-Hevia; Salvadora Delgado; Antoni Castells; Marta Tasende; Dulce Momblan; Gabriel Díaz del Gobbo; Borja DeLacy; Jaume Balust; Antonio M Lacy Journal: Ann Surg Date: 2015-02 Impact factor: 12.969
Authors: Mark S Roh; Linda H Colangelo; Michael J O'Connell; Greg Yothers; Melvin Deutsch; Carmen J Allegra; Morton S Kahlenberg; Luis Baez-Diaz; Carol S Ursiny; Nicholas J Petrelli; Norman Wolmark Journal: J Clin Oncol Date: 2009-09-21 Impact factor: 44.544
Authors: Charlotte L Deijen; Simone Velthuis; Alice Tsai; Stella Mavroveli; Elly S M de Lange-de Klerk; Colin Sietses; Jurriaan B Tuynman; Antonio M Lacy; George B Hanna; H Jaap Bonjer Journal: Surg Endosc Date: 2015-11-04 Impact factor: 4.584
Authors: Roberto Peltrini; Gaetano Luglio; Gianluca Cassese; Alfonso Amendola; Emanuele Caruso; Michele Sacco; Gianluca Pagano; Viviana Sollazzo; Antonio Tufano; Mariano Cesare Giglio; Luigi Bucci; Giovanni Domenico De Palma Journal: Open Med (Wars) Date: 2019-09-12
Authors: N S Fearnhead; A G Acheson; S R Brown; L Hancock; A Harikrishnan; S B Kelly; C A Maxwell-Armstrong; P M Sagar; S Siddiqi; C J Walsh; J M D Wheeler; J F Abercrombie Journal: Colorectal Dis Date: 2020-07 Impact factor: 3.788