Transanal total mesorectal excision for rectal cancer has been suspended in Norway

Background Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan-Meier estimates were used to compare local recurrence. Results In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7 center dot 6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2 center dot 4 years was 11 center dot 6 (95 per cent c.i. 6 center dot 6 to 19 center dot 9) per cent after TaTME compared with 2 center dot 4 (1 center dot 4 to 4 center dot 3) per cent in the NCCR (P < 0 center dot 001). The adjusted hazard ratio was 6 center dot 71 (95 per cent c.i. 2 center dot 94 to 15 center dot 32). Anastomotic leaks resulting in reoperation occurred in 8 center dot 4 per cent of patients in the TaTME cohort compared with 4 center dot 5 per cent in NoRGast (P = 0 center dot 047). Fifty-six patients (35 center dot 7 per cent) had a stoma at latest follow-up; 39 (24 center dot 8 per cent) were permanent. Conclusion Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.