Transanal Total Mesorectal Excision for Rectal Cancer: Short and Midterm Results

Abstract

Background: Colorectal cancer is the third most common cancer affecting men and women in most Western countries and is the leading cause of cancer-related deaths. The primary goal of surgery is complete removal of rectal cancer. Total mesorectal excision (TME) is the cornerstone of curative therapy for rectal adenocarcinoma. Transanal total mesorectal excision (TaTME) was introduced for mid and lower rectal cancer and is proposed to allow a precise mesorectal dissection through better visualization in the anatomically limited pelvis. We aimed to check the feasibility of TaTME in terms of the quality of TME, circumferential resection margin positivity, lymph node yield, operation time, mean blood loss, postoperative complications, conversion rate, and hospital stay.Methods: This was a cohort study from July 2018 to June 2020 to validate the efficacy of TaTME in our setup. It included biopsy-proven low and mid-rectal cancers (4-8 cm from the anal verge), T1 with node-positive disease or T2 and T3 with or without nodal disease. Statistical analysis was done by using SPSS software v24.Results: Out of the total patients studied (n=35), 30 (85.7%) were men, and the rest were women. 14 patients received neoadjuvant therapy (40%). Overall, 30 (85.7%) had complete mesorectal excision, 4 (11.5%) patients had near complete mesorectal excision, and one had poor excision. 25 (71.4%) had moderately differentiated adenocarcinoma, 7 (20%) had poorly differentiated adenocarcinoma, and 3 (8.6%) had well-differentiated adenocarcinoma. 34 patients (97.2%) had normal distal resection margins, and only one (2.8%) had positive distal resection margins. Only 2 (5.8%) patients had positive circumferential resection margins (CRM). The mean tumor distance from the anal verge was 4.97 cm. The mean lymph node yield was 7.86±1.73. The mean operation time was 2.095 ±0.461 hours. The mean blood loss was 48.57±11.92 ml. Most patients (71.4%) had no postoperative complications at one month. However, urinary tract infection (8.6%), surgical site infection (5.7%), acute kidney injury (2.9%), anastomotic leak (2.9%), incontinence (2.9%), stromal retraction (2.9%), and rectovaginal fistula (2.9%) were noted. After three months, most patients had no complications (88.6%), though subacute intestinal obstruction occurred in 2 (5.7%) and sexual dysfunction occurred in 2 patients (5.7%). The mean hospital stay was 11.09±2.08 days.Conclusion: The present study suggests TaTME might be a feasible method for oncologic resection of locally advanced mid- and distal-rectal cancer with curative intent. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications were very satisfactory. Short-term morbidity and oncologic outcomes were as good as in other laparoscopic TME series.

Keywords

• colorectal cancer
• rectal cancer
• transanal total mesorectal excision