H H Wasmuth1, A E Faerden2, T Å Myklebust3,4, F Pfeffer5,6, S Norderval7, R Riis2, O C Olsen8, J R Lambrecht9, H Kørner6,10, S G Larsen11, H M Forsmo, O Baekkelund, S Lavik, J C Knapp, O Sjo, G Rashid. 1. Department of Gastrointestinal Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway. 2. Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway. 3. Department of Registration, Cancer Registry Norway, Oslo, Norway. 4. Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway. 5. Department of Surgery, Haukeland University Hospital, Bergen, Norway. 6. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 7. Department of Gastrointestinal Surgery, Tromsø University Hospital, University of Northern Norway, Tromsø, Norway. 8. Department of Gastrointestinal Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. 9. Department of Surgery, Gjøvik Hospital, Innlandet Hospital Trust, Gjøvik, Norway. 10. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. 11. Department of Gastrointestinal Surgery, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Abstract
BACKGROUND: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. METHODS: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. RESULTS: In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7·6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2·4 years was 11·6 (95 per cent c.i. 6·6 to 19·9) per cent after TaTME compared with 2·4 (1·4 to 4·3) per cent in the NCCR (P < 0·001). The adjusted hazard ratio was 6·71 (95 per cent c.i. 2·94 to 15·32). Anastomotic leaks resulting in reoperation occurred in 8·4 per cent of patients in the TaTME cohort compared with 4·5 per cent in NoRGast (P = 0·047). Fifty-six patients (35·7 per cent) had a stoma at latest follow-up; 39 (24·8 per cent) were permanent. CONCLUSION: Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.
BACKGROUND: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. METHODS: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. RESULTS: In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7·6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2·4 years was 11·6 (95 per cent c.i. 6·6 to 19·9) per cent after TaTME compared with 2·4 (1·4 to 4·3) per cent in the NCCR (P < 0·001). The adjusted hazard ratio was 6·71 (95 per cent c.i. 2·94 to 15·32). Anastomotic leaks resulting in reoperation occurred in 8·4 per cent of patients in the TaTME cohort compared with 4·5 per cent in NoRGast (P = 0·047). Fifty-six patients (35·7 per cent) had a stoma at latest follow-up; 39 (24·8 per cent) were permanent. CONCLUSION:Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.
Authors: Alen Antoun; Johnny Chau; Nourah Alsharqawi; Pepa Kaneva; Liane S Feldman; Carmen L Mueller; Lawrence Lee Journal: Surg Endosc Date: 2020-09-01 Impact factor: 4.584
Authors: Ivy H Gardner; Katherine A Kelley; Walaa F Abdelmoaty; Ahmed Sharata; Amanda V Hayman; Mark H Whiteford Journal: Surg Endosc Date: 2021-01-08 Impact factor: 4.584