The role of transanal compared to laparoscopic total mesorectal excision for the treatment of rectal cancer in obese patients: a multicenter propensity-matched analysis
EAES Academy. Tejedor P. 07/05/22; 362990; P033
Dr. Patricia Tejedor
Contributions
Contributions
Abstract
AIM:
To compare the rate of sphincter-saving interventions between transanal Total Mesorectal Excision (taTME) and laparoscopic Total Mesorectal Excision (lapTME) in a challenging group of obese patients with rectal cancer.
Methods:
A multicentre retrospective review was performed selecting consecutive patients diagnosed with rectal cancer below the peritoneal reflection and BMI≥30 Kg/m2, who underwent minimally invasive elective surgery. Exclusion criteria were 1)sphincter and/or puborectalis invasion; 2)multivisceral resections; 3)palliative surgeries. The study population was divided into two groups according to the type of intervention: taTME or lapTME. A propensity-matched analysis was performed in a 1:1 design based on gender and neoadjuvant chemoradiotherapy (nCRT).
Results:
A cohort of 93 patients over a 5-year period were included. Of them, 41 underwent taTME (44%) and 52 lapTME (56%); median age 67 (56-75) yrs, male:female 66:34, median BMI 32 (31-33) Kg/m2. Median tumour height was 6 (5-8) cm, 61% received nCRT, with an overall percentage of sphincter-saving surgery of 83%.
A total of 41 patients who underwent taTME were case-matched with 41 patients who underwent lapTME. In the taTME group, 51% had low rectal cancer compared to 32% in the lapTME group (p=0.141); however, the rate of sphincter-saving surgery was significantly higher in the taTME group (95% vs. 71%, p=0.003). There were no conversions in the taTME group, compared to 3 cases in the lapTME group (7%) (p=0.078). The percentage of major complications was similar (10% taTME vs. 7% lapTME, p=0.275), including the rate of clinical anastomotic leak (8% taTME vs. 15% lapTME, p=0.377).
Pathological outcomes were similar; median distal resection margin was 10 mm in both groups, there were no cases of affected distal margin in the taTME group vs. 3 cases (7%) lapTME, p=0.079). The quality of the mesorectum and the circumferential resection margin were similar in both groups.
Conclusions:
In our experience, the transanal approach has improved the rate of sphincter-saving surgery in a very challenging group of obese patients, diagnosed with mid-low rectal cancer.
To compare the rate of sphincter-saving interventions between transanal Total Mesorectal Excision (taTME) and laparoscopic Total Mesorectal Excision (lapTME) in a challenging group of obese patients with rectal cancer.
Methods:
A multicentre retrospective review was performed selecting consecutive patients diagnosed with rectal cancer below the peritoneal reflection and BMI≥30 Kg/m2, who underwent minimally invasive elective surgery. Exclusion criteria were 1)sphincter and/or puborectalis invasion; 2)multivisceral resections; 3)palliative surgeries. The study population was divided into two groups according to the type of intervention: taTME or lapTME. A propensity-matched analysis was performed in a 1:1 design based on gender and neoadjuvant chemoradiotherapy (nCRT).
Results:
A cohort of 93 patients over a 5-year period were included. Of them, 41 underwent taTME (44%) and 52 lapTME (56%); median age 67 (56-75) yrs, male:female 66:34, median BMI 32 (31-33) Kg/m2. Median tumour height was 6 (5-8) cm, 61% received nCRT, with an overall percentage of sphincter-saving surgery of 83%.
A total of 41 patients who underwent taTME were case-matched with 41 patients who underwent lapTME. In the taTME group, 51% had low rectal cancer compared to 32% in the lapTME group (p=0.141); however, the rate of sphincter-saving surgery was significantly higher in the taTME group (95% vs. 71%, p=0.003). There were no conversions in the taTME group, compared to 3 cases in the lapTME group (7%) (p=0.078). The percentage of major complications was similar (10% taTME vs. 7% lapTME, p=0.275), including the rate of clinical anastomotic leak (8% taTME vs. 15% lapTME, p=0.377).
Pathological outcomes were similar; median distal resection margin was 10 mm in both groups, there were no cases of affected distal margin in the taTME group vs. 3 cases (7%) lapTME, p=0.079). The quality of the mesorectum and the circumferential resection margin were similar in both groups.
Conclusions:
In our experience, the transanal approach has improved the rate of sphincter-saving surgery in a very challenging group of obese patients, diagnosed with mid-low rectal cancer.
AIM:
To compare the rate of sphincter-saving interventions between transanal Total Mesorectal Excision (taTME) and laparoscopic Total Mesorectal Excision (lapTME) in a challenging group of obese patients with rectal cancer.
Methods:
A multicentre retrospective review was performed selecting consecutive patients diagnosed with rectal cancer below the peritoneal reflection and BMI≥30 Kg/m2, who underwent minimally invasive elective surgery. Exclusion criteria were 1)sphincter and/or puborectalis invasion; 2)multivisceral resections; 3)palliative surgeries. The study population was divided into two groups according to the type of intervention: taTME or lapTME. A propensity-matched analysis was performed in a 1:1 design based on gender and neoadjuvant chemoradiotherapy (nCRT).
Results:
A cohort of 93 patients over a 5-year period were included. Of them, 41 underwent taTME (44%) and 52 lapTME (56%); median age 67 (56-75) yrs, male:female 66:34, median BMI 32 (31-33) Kg/m2. Median tumour height was 6 (5-8) cm, 61% received nCRT, with an overall percentage of sphincter-saving surgery of 83%.
A total of 41 patients who underwent taTME were case-matched with 41 patients who underwent lapTME. In the taTME group, 51% had low rectal cancer compared to 32% in the lapTME group (p=0.141); however, the rate of sphincter-saving surgery was significantly higher in the taTME group (95% vs. 71%, p=0.003). There were no conversions in the taTME group, compared to 3 cases in the lapTME group (7%) (p=0.078). The percentage of major complications was similar (10% taTME vs. 7% lapTME, p=0.275), including the rate of clinical anastomotic leak (8% taTME vs. 15% lapTME, p=0.377).
Pathological outcomes were similar; median distal resection margin was 10 mm in both groups, there were no cases of affected distal margin in the taTME group vs. 3 cases (7%) lapTME, p=0.079). The quality of the mesorectum and the circumferential resection margin were similar in both groups.
Conclusions:
In our experience, the transanal approach has improved the rate of sphincter-saving surgery in a very challenging group of obese patients, diagnosed with mid-low rectal cancer.
To compare the rate of sphincter-saving interventions between transanal Total Mesorectal Excision (taTME) and laparoscopic Total Mesorectal Excision (lapTME) in a challenging group of obese patients with rectal cancer.
Methods:
A multicentre retrospective review was performed selecting consecutive patients diagnosed with rectal cancer below the peritoneal reflection and BMI≥30 Kg/m2, who underwent minimally invasive elective surgery. Exclusion criteria were 1)sphincter and/or puborectalis invasion; 2)multivisceral resections; 3)palliative surgeries. The study population was divided into two groups according to the type of intervention: taTME or lapTME. A propensity-matched analysis was performed in a 1:1 design based on gender and neoadjuvant chemoradiotherapy (nCRT).
Results:
A cohort of 93 patients over a 5-year period were included. Of them, 41 underwent taTME (44%) and 52 lapTME (56%); median age 67 (56-75) yrs, male:female 66:34, median BMI 32 (31-33) Kg/m2. Median tumour height was 6 (5-8) cm, 61% received nCRT, with an overall percentage of sphincter-saving surgery of 83%.
A total of 41 patients who underwent taTME were case-matched with 41 patients who underwent lapTME. In the taTME group, 51% had low rectal cancer compared to 32% in the lapTME group (p=0.141); however, the rate of sphincter-saving surgery was significantly higher in the taTME group (95% vs. 71%, p=0.003). There were no conversions in the taTME group, compared to 3 cases in the lapTME group (7%) (p=0.078). The percentage of major complications was similar (10% taTME vs. 7% lapTME, p=0.275), including the rate of clinical anastomotic leak (8% taTME vs. 15% lapTME, p=0.377).
Pathological outcomes were similar; median distal resection margin was 10 mm in both groups, there were no cases of affected distal margin in the taTME group vs. 3 cases (7%) lapTME, p=0.079). The quality of the mesorectum and the circumferential resection margin were similar in both groups.
Conclusions:
In our experience, the transanal approach has improved the rate of sphincter-saving surgery in a very challenging group of obese patients, diagnosed with mid-low rectal cancer.
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