Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME

Abstract

Mateusz Rubinkiewicz,1 Michał Nowakowski,2 Mateusz Wierdak,1,3 Magdalena Mizera,1 Marcin Dembiński,1 Magdalena Pisarska,1,3 Piotr Major,1,3 Piotr Małczak,1,3 Andrzej Budzyński,1,3 Michał Pędziwiatr1,3 12nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland; 2Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland; 3Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland Background: Transanal total mesorectal excision (TaTME) is emerging as a novel alternative to laparoscopic total mesorectal excision (LaTME). The aim of this study was to compare clinical and pathological results from these two techniques in patients undergoing rectal resections because of low rectal cancer. Materials and methods: Thirty-five patients undergoing TaTME were matched with 35 patients operated on using LaTME. Composite primary endpoint (complete TME, negative circumferential resection margin [pCRM], and distal resection margin [pDRM]) was used to assess pathological quality specimens. Secondary outcomes included operative and postoperative parameters (operative time, total blood loss, postoperative morbidity, length of stay, 30-day mortality). Results: Composite primary endpoint was achieved by 85% of subjects in the TaTME group and 82% of subjects in the LaTME group (P=0.66). Mean pCRM was 1.1±1.29 vs 0.99±0.78 mm (P=0.25). Distal pDRM was 1.57±0.92 and 1.98±1.22 cm (P=0.15). In the TaTME and LaTME groups, respectively, complete mesorectal excision was achieved in 89% and 83% of subjects, while excision was nearly complete for the remaining 11% and 17% (P=0.23). Conclusion: TaTME appears to be a noninferior alternative to laparoscopic surgery. TaTME allows for quality retrieval of surgical specimens with comparable clinical outcomes with LaTME. Keywords: transanal TME, laparoscopic TME, rectal cancer, low rectal cancer, minimally invasive surger