Completion Total Mesorectal Excision Following Transanal Endoscopic Microsurgery Does Not Compromise Outcomes in Patients with Rectal Cancer

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2021 Feb 25

PMID 33629183

Citations 10

Authors

Katarina Levic Souzani

Orhan Bulut

Tine Plato Kuhlmann

Ismail Gogenur

Thue Bisgaard

Affiliations

Soon will be listed here.

Abstract

Background: Transanal endoscopic microsurgery (TEM) represents a choice of treatment in patients with neoplastic lesions in the rectum. When TEM fails, completion total mesorectal excision (cTME) is often required. However, a concern is whether cTME increases the rate of abdominoperineal resections (APR) and is associated with higher risk of incomplete mesorectal fascia (MRF) resection. The aim of this study was to compare outcomes of cTME with primary TME (pTME) in patients with rectal cancer.

Methods: This was a nationwide study on all patients with cTME from the Danish Colorectal Cancer Group database between 2005 and 2015. Patients with cTME were compared to patients with pTME after propensity score matching (matching ratio 1:2). Matching variables were age, gender, tumor distance from anal verge, American Society of Anesthesiologists (ASA) score and American Joint Committee on Cancer (AJCC) stage.

Results: A total of 60 patients with cTME were compared with 120 patients with pTME. Patients with cTME experienced more intraoperative complications as compared to pTME patients (18.3% vs. 6.7%, p = 0.021). However, there was no difference in the rate of perforations at or near the tumor/previous TEM site (6.7% vs. 2.5%, p = 0.224), conversion to open surgery (p = 0.733) or 30-day morbidity (p = 0.86). On multivariate analysis, cTME was not a risk factor for APR (OR 2.49; 95% CI 0.95-6.56; p = 0.064) or incomplete MRF (OR 1.32; 95% CI 0.48-3.63; p = 0.596). There was no difference in the rate of local recurrence between cTME and pTME (5.2% vs. 4.3%, p = 0.1), distant metastases (6.8% vs. 6.8%, p = 1), or survival (p = 0.081). The mean follow-up time was 6 years.

Conclusion: In our study, the largest so far on the subject, we find no difference in postoperative short- or long-term outcomes between cTME and pTME.

Citing Articles

Oncologic safety and technical feasibility of completion transanal total mesorectal excision after local excision; a cohort study from the International TaTME Registry.

Dingemans S, Kreisel S, Rutgers M, Musters G, Hompes R, Brown C Surg Endosc. 2024; 39(2):970-977.

PMID: 39663245 DOI: 10.1007/s00464-024-11390-w.

Short-term outcomes after primary total mesorectal excision (TME) versus local excision followed by completion TME for early rectal cancer: population-based propensity-matched study.

van Lieshout A, Smits L, Sijmons J, van Dieren S, van Oostendorp S, Tanis P BJS Open. 2024; 8(5).

PMID: 39235090 PMC: 11375580. DOI: 10.1093/bjsopen/zrae103.

Survival prognostic in different age groups of patients undergoing local versus radical excision for rectal cancer: a study based on the SEER database.

Li J, Wen L, Ma Y, Zhang G, Wang P, Huang C Updates Surg. 2024; 76(3):975-988.

PMID: 38704811 DOI: 10.1007/s13304-024-01846-y.

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients.

Dekkers N, Dang H, Vork K, Langers A, van der Kraan J, Westerterp M Cancers (Basel). 2023; 15(18).

PMID: 37760458 PMC: 10526268. DOI: 10.3390/cancers15184490.

Completion Total Mesorectal Excision: A Case-Matched Comparison With Primary Resection.

Burghgraef T, Rutgers M, Leijtens J, Tuyman J, Consten E, Hompes R Ann Surg Open. 2023; 4(3):e327.

PMID: 37746593 PMC: 10513327. DOI: 10.1097/AS9.0000000000000327.

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