Transanal total mesorectal excision compared to laparoscopic TME for mid and low rectal cancer - current evidence

Stefan E. van Oostendorp*, Thomas W. A. Koedam, Colin Sietses, H. Jaap Bonier, Jurriaan B. Tuynman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Transanal total mesorectal excision (TaTME) is potentially the answer to refractory challenges in rectal cancer surgery. The surgical dissection in the deep pelvis is facilitated by a down to up approach with modern laparoscopic techniques. Potential benefits are decrease in short-term morbidity including anastomotic leakages, in conversion and colostomy rate, and better quality of specimens including less R1 rates. Long-term oncological outcome data is lacking and needs to be reviewed thoroughly. Initial (comparative) series show promising results, however there is a lack of audited data and comparative data between laparoscopic TME (LaTME) and TaTME. This review compares available data of LaTME and TaTME.

Methods: A systematic review was performed in PubMed to identify papers reporting TaTME series with minimal 15 patients. A comparative set of recent large RCT data on LaTME was constructed. Weighted averages were derived from the extracted data. Primary endpoints were short-term morbidity, anastomotic leakage, conversion, pathological outcomes and local recurrences (LR).

Results: The search yielded 1,093 papers, of which after the selection process resulted in the inclusion of 23 series on TaTME. To make a comparison, the four latest RCT’s on LaTME were identified as a referential group. The international TaTME registry paper was presented separately to make a third comparative group. Average morbidity 31.5% and 39.6% and anastomotic leakage 6.9% vs. 8.0% both in favor of TaTME. Conversion rate was 2.0% vs. 15.7% for TaTME and LaTME respectively. Complete mesorectal integrity 86.2% vs. 81.5% and CRM+ 4.6% vs. 7.9%. Five urethral injuries (0.7%) were reported. Long-term outcomes of LRs were reported in a minority of studies with heterogeneous follow-up intervals.

Conclusions: This review summarizes the data and potential benefits of TaTME. Compared to LaTME, TaTME decreases short-term morbidity, conversion, suboptimal quality of the specimen and involved CRM rate. Due to concerns about underreporting of poor outcomes, a well-designed randomized controlled trial with quality assurance and report on oncological safety is needed before widespread implementation can be justified.
Original languageEnglish
JournalANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY
Volume3
Issue number5
DOIs
Publication statusPublished - 10 May 2018

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