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An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

(2018) In Colorectal Disease 20(Suppl 6). p.33-46
Abstract

INTRODUCTION: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.

RESULTS: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative... (More)

INTRODUCTION: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.

RESULTS: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P = 0.39 and OR 2.11, 0.79-5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P < 0.001) and male gender (OR 2.29, 1.52-3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.

CONCLUSION: This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.

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LU
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aged, Elective Surgical Procedures/methods, Female, Humans, Laparoscopy/methods, Male, Margins of Excision, Medical Audit, Middle Aged, Operative Time, Postoperative Complications/etiology, Proctectomy/methods, Prospective Studies, Rectal Neoplasms/surgery, Rectum/surgery, Robotic Surgical Procedures/methods, Transanal Endoscopic Surgery/methods, Treatment Outcome
in
Colorectal Disease
volume
20
issue
Suppl 6
pages
33 - 46
publisher
Wiley-Blackwell
external identifiers
  • pmid:30255642
  • scopus:85053850955
ISSN
1462-8910
DOI
10.1111/codi.14376
language
English
LU publication?
yes
additional info
Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.
id
76ba0f47-c645-4bc5-8755-b45ee8a48e02
date added to LUP
2021-12-29 12:01:22
date last changed
2024-04-06 16:11:40
@article{76ba0f47-c645-4bc5-8755-b45ee8a48e02,
  abstract     = {{<p>INTRODUCTION: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.</p><p>METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.</p><p>RESULTS: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P = 0.39 and OR 2.11, 0.79-5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P &lt; 0.001) and male gender (OR 2.29, 1.52-3.44, P &lt; 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.</p><p>CONCLUSION: This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.</p>}},
  issn         = {{1462-8910}},
  keywords     = {{Aged; Elective Surgical Procedures/methods; Female; Humans; Laparoscopy/methods; Male; Margins of Excision; Medical Audit; Middle Aged; Operative Time; Postoperative Complications/etiology; Proctectomy/methods; Prospective Studies; Rectal Neoplasms/surgery; Rectum/surgery; Robotic Surgical Procedures/methods; Transanal Endoscopic Surgery/methods; Treatment Outcome}},
  language     = {{eng}},
  number       = {{Suppl 6}},
  pages        = {{33--46}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)}},
  url          = {{http://dx.doi.org/10.1111/codi.14376}},
  doi          = {{10.1111/codi.14376}},
  volume       = {{20}},
  year         = {{2018}},
}