Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

Martínez, María Labalde; Lopez, Alfredo Vivas; Jimenez, Juan Ocaña; García, Cristina Nevado; Villar, Oscar García; Gonzalez, Eduardo Rubio; Borda, Francisco Javier García; Vigo, Felipe Cruz; Herrero, Eduardo Ferrero

doi:10.1055/s-0041-1736640

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Brasil

Journal of Coloproctology (Rio de Janeiro)

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Brasil

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Original Article • J. Coloproctol. (Rio J.) 41 (04) • Oct-Dec 2021 • https://doi.org/10.1055/s-0041-1736640 copy

Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME).

Methods

A cohort prospective study with 50 (14 female and 36male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed.

Results

There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the external anal margin) between the two groups. The rates of: postoperativemorbidity (TaTME: 35%; LaTME: 30%; p=0.763);mortality (0%); anastomotic leak (TaTME: 10%; LaTME: 13%; p=0.722); wound infection (TaTME: 0%; LaTME: 3.3%; p=0.409); reoperation (TaTME: 5%; LaTME: 6.6%; p=0.808); and readmission (TaTME: 5%; LaTME: 0%; p=0.400), as well as the length of the hospital stay (TaTME: 13.5 days; LaTME: 11 days; p=0.538), were similar in both groups. There were no statistically significant differences in the rates of positive circumferential resection margin (TaTME: 5%; LaTME: 3.3%; p=0.989) and positive distal resection margin (TaTME: 0%; LaTME: 3.3%; p=0.400), the completeness of the TME (TaTME: 100%; LaTME: 100%), and the number of lymph nodes harvested (TaTME: 15; LaTME: 15.5; p=0.882) between two groups.

Conclusion

Transanal total mesorectal excision is a safe and feasible surgical procedure for middle/lower-third rectal cancer.

Keywords:
rectal cancer; transanal total mesorectal excision rectal cancer surgery; TaTME; quality indicators of rectal cancer surgery

	Total(n = 50)	TaTME(n = 20)	LaTME(n = 30)	p-value
Gender
Male	36 (72%)	13 (65%)	23 (76.7%)	0.363
Female	14 (28%)	7 (35%)	7 (23.3%)	0.363
Age (years)	67 (55.7–75.2)	66.5 (55.5–66.5)	67 (55.7–73)	0.977
ASA score
I	2 (4%)	2 (10%)	0	0.086
II	20 (40%)	5 (25%)	15 (50%)
III	27 (54%)	12 (60%)	15 (50%)
IV	1 (2%)	1 (5%)	0
BMI (kg/m²)	25.3 (23.7–28.1)	25.7 (22.5–28.6)	25.1 (23.7–28.1)	0.488
Tumor location
Lower third of the rectum	15 (30%)	7 (35%)	8 (26.6%)	0.529
Middle third of the rectum	35 (70%)	13 (65%)	22 (73.3%)	0.529
Distance of the tumor from the anal verge (cm)	7 (4–8)	7 (4–7)	6 (4–7)	0.273
Preoperative stage
cT1	6 (12%)	1 (5%)	5 (16.7%)	0.380
cT2	10 (20%)	6 (30%)	4 (13.3%)	0.729
cT3	26 (52%)	10 (50%)	16 (53.3%)
cT4	8 (16%)	3 (15%)	5 (16.7%)
cN+	24 (48%)	9 (45%)	15 (50%)
CEA (ng/mL)	3.7 (1.8–6.5)	4.7 (1.44–7.35)	2.74 (1.86–6.3)	0.187
Neoadjuvant therapy	26 (52%)	11 (55%)	15 (50%)	0.726
Pathological tumor stage
pT3-4	21 (42%)	9 (45%)	13 (43.3%)	0.880
N+	11 (22%)	5 (25%)	6 (20%)	0.736
Ryan tumor regression grade system
Grade 0	2 (4%)	1 (5%)	1 (3.3%)	0.384
Grade 1	4(8%)	2 (10%)	2 (6.6%)
Grade 2	6(12%)	1(5%)	5 (16.6%)
Grade 3	11(22%)	6(30%)	5 (16.6%)
Grade 4	2 (4%)	0	2 (6.6%)
Grade 5	1 (2%)	1(5%)	0

	Total(N = 50)	TaTME(N = 20)	LaTME(N = 30)	p-value
Operative time	290 (225–300)	367 (292–420)	240 (196–240)	0.001^*
Rate of postoperative morbidity	16 (32%)	7 (35%)	9 (30%)	0.763
Clavien-Dindo classification
I-II	13 (26%)	6 (30%)	7 (23.3%)	0.808
III-IV	3 (6%)	1 (5%)	2 (6.6%)	0.808
Rate of anastomotic leak	6 (12%)	2 (10%)	4 (13%)	0.722
Rate of abdominal wound infection	1 (2%)	0	1 (3.3%)	0..409
Length of hospital stay (days)	11 (7–17)	13,5 (8.2–17)	11 (7–17)	0.538
Reoperation rate	3 (6%)	1 (5%)	2 (6.6%)	0.808
Readmission rate	1 (2%)	1 (5%)	0	0.400
Mortality	1 (2%)	0	1 (3.3%)	0.400
Positive CRM	2 (4%)	1 (5%)	1 (3.3%)	0.989
Positive DRM	1 (2%)	0	1 (3.3%)	0.400
Complete-nearly complete TME	50 (100%)	20 (100%)	30 (100%)	–
Number of lymph nodes harvested	15 (12–21.2)	15 (12–20.5)	15.5 (10.7–22)	0.882

	β coefficient	p-value	Odds ratio	95% confidence interval
Morbidity	0.228	0.711	1.256	0.376–4.196
Positive circumferential resection margin	0.423	0.770	1.526	0.090–25.904
Positive distal resection margin	-0.405	0.160	0.667	0.001–36.923

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[1] Address for correspondence Maria Labalde Martínez, MD, PhD, Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Aparato Digestivo y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n,Madrid - 28041, Spain (e-mail: mlabaldemartinez@yahoo.es).