Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases

Marta Penna, Roel Hompes*, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B. Hanna, Neil J. Mortensen, Paris P. Tekkis, Matthew Albert, Hazar Al Furajii, Andrew Allison, Alberto Arezzo, Kamal Aryal, Shazad Ashraf, Sam Atallah, Khurrum Baig, Jörg Baral, Willem BemelmanDavid Berger, Luigi Boni, Jaap Bonjer, Liliana Bordeianou, Dario Borreca, Nicolas Christian Buchs, Ronan Cahill, Ken Campbell, Gabriella Capolupo, Marco Caricato, Elisa Cassinotti, William Chambers, Edward Douglas Courtney, Christopher Cunningham, Stephan Dalton, Robin Dawson, Paolo Delrio, Eelco De Graaf, Paolo De Paolis, Mathieu D'Hondt, André D'Hoore, Pascal Doornebosch, Jens Ravn Erikson, Lope Estévez-Schwarz, Miroslava Fabryko, Maria Fernández-Hevia, Joep Knol, Colin Sietses, Jurriaan Tuynman, Simone Velthuis, the TaTME Registry Collaborative

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology. Background: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population. Methods: Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome. Results: A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m 2. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor <2 cm from anorectal junction, and laparoscopic transabdominal posterior dissection to <4 cm from anal verge. Conclusions: TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.

Original languageEnglish
Pages (from-to)111-117
Number of pages7
JournalAnnals of Surgery
Volume266
Issue number1
DOIs
Publication statusPublished - 2017

Cite this

Penna, M., Hompes, R., Arnold, S., Wynn, G., Austin, R., Warusavitarne, J., ... the TaTME Registry Collaborative (2017). Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Annals of Surgery, 266(1), 111-117. https://doi.org/10.1097/SLA.0000000000001948