F Letarte1, M Raval1, A Karimuddin1, P T Phang1, C J Brown2,3,4. 1. Department of Colorectal Surgery, St. Paul's Hospital Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 2. Department of Colorectal Surgery, St. Paul's Hospital Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. cbrown@providencehealth.bc.ca. 3. Division of General Surgery, Providence Health Care, Vancouver, Canada. cbrown@providencehealth.bc.ca. 4. Section of Colorectal Surgery, St. Paul Hospital, University of British Columbia (UBC), C310-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada. cbrown@providencehealth.bc.ca.
Abstract
BACKGROUND: Salvage surgery after transanal endoscopic microsurgery (TEM) has shown mixed results. Transanal total mesorectal excision (TaTME) might be advantageous in this population. The aim of this study was to assess the short-term oncologic and operative outcomes of salvage surgery after TEM, comparing TaTME to conventional salavge TME (sTME). METHODS: Consecutive patients treated with salvage surgery after TEM were identified. Patients who underwent TaTME were compared to those who had conventional sTME. The primary outcome was the ability to perform an appropriate oncologic procedure defined by a composite outcome (negative distal margins, negative radial margins and complete or near complete mesorectum specimen). RESULTS: During the study period, 41 patients had salvage surgery after TEM. Of those, 11 patients had TaTME while 30 patients had sTME. All patients in the TaTME group met the composite outcome of appropriate oncologic procedure compared to 76.7% for the conventional sTME group (p = 0.19). TaTME was associated with significantly higher rates of sphincter preservation (100 vs. 50%, p = 0.01), higher rates of laparoscopic surgery (100 vs. 23.3%, p < 0.001) and lower rates of conversion to open surgery (9.1 vs. 57%, p < 0.001). No difference was found in postoperative morbidity (36.3 vs. 36.7%, p = 0.77). CONCLUSIONS: The present study demonstrates that for patients requiring salvage surgery after TEM, TaTME is associated with significantly higher rates of sphincter-sparing surgery when compared to conventional transabdominal TME while producing adequate short-term oncologic outcomes. Salvage surgery after TEM might be a clear indication for TaTME rather than conventional surgery.
BACKGROUND: Salvage surgery after transanal endoscopic microsurgery (TEM) has shown mixed results. Transanal total mesorectal excision (TaTME) might be advantageous in this population. The aim of this study was to assess the short-term oncologic and operative outcomes of salvage surgery after TEM, comparing TaTME to conventional salavge TME (sTME). METHODS: Consecutive patients treated with salvage surgery after TEM were identified. Patients who underwent TaTME were compared to those who had conventional sTME. The primary outcome was the ability to perform an appropriate oncologic procedure defined by a composite outcome (negative distal margins, negative radial margins and complete or near complete mesorectum specimen). RESULTS: During the study period, 41 patients had salvage surgery after TEM. Of those, 11 patients had TaTME while 30 patients had sTME. All patients in the TaTME group met the composite outcome of appropriate oncologic procedure compared to 76.7% for the conventional sTME group (p = 0.19). TaTME was associated with significantly higher rates of sphincter preservation (100 vs. 50%, p = 0.01), higher rates of laparoscopic surgery (100 vs. 23.3%, p < 0.001) and lower rates of conversion to open surgery (9.1 vs. 57%, p < 0.001). No difference was found in postoperative morbidity (36.3 vs. 36.7%, p = 0.77). CONCLUSIONS: The present study demonstrates that for patients requiring salvage surgery after TEM, TaTME is associated with significantly higher rates of sphincter-sparing surgery when compared to conventional transabdominal TME while producing adequate short-term oncologic outcomes. Salvage surgery after TEM might be a clear indication for TaTME rather than conventional surgery.
Authors: Dieter Hahnloser; Bruce G Wolff; David W Larson; Jennifer Ping; Santhat Nivatvongs Journal: Dis Colon Rectum Date: 2005-03 Impact factor: 4.585
Authors: S Galandiuk; V W Fazio; D G Jagelman; I C Lavery; F A Weakley; R E Petras; K Badhwar; B McGonagle; K Eastin; T Sutton Journal: Am J Surg Date: 1987-01 Impact factor: 2.565
Authors: S H E M Clermonts; Y T van Loon; A H W Schiphorst; D K Wasowicz; D D E Zimmerman Journal: Int J Colorectal Dis Date: 2017-09-13 Impact factor: 2.571
Authors: Anandi H W Schiphorst; Barbara S Langenhoff; John Maring; Apollo Pronk; David D E Zimmerman Journal: Dis Colon Rectum Date: 2014-08 Impact factor: 4.585
Authors: Antonio Caycedo-Marulanda; Lawrence Lee; Sami A Chadi; Chris P Verschoor; Jordan Crosina; Shady Ashamalla; Carl J Brown Journal: JAMA Netw Open Date: 2021-02-01
Authors: S H E M Clermonts; T Köeter; H Pottel; L P S Stassen; D K Wasowicz; D D E Zimmerman Journal: Colorectal Dis Date: 2020-02-04 Impact factor: 3.788