Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia

BackgroundThe surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME).MethodsThis was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up >= 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed.ResultsOne hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%.ConclusionsTaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Automated summary

This study evaluated the early experience with transanal total mesorectal excision (TaTME) in the surgical treatment of rectal neoplasia. The results showed that TaTME had comparable surgical, anatomopathological, and oncological outcomes at 3 years (medium-term) to laparoscopic and open approaches. However, better monitoring is required for long-term functional and quality of life outcomes.