Transanal total mesorectal excision for stage II or III rectal cancer: pattern of local recurrence in a tertiary referral center

Transanal total mesorectal excision for stage II or III rectal cancer: pattern of local recurrence in a tertiary referral center

Background For mid and low rectal cancer, transanal total mesorectal excision (TaTME) has been established as an alternative approach to laparoscopic surgery. However, there are concerns about an unexpected pattern of local recurrence. This study aimed to analyze the pattern of local recurrence for...

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Bibliographic Details
Published in:Surgical endoscopy Vol. 35; no. 12; pp. 7191 - 7199
Main Authors: González-Abós, Carolina, de Lacy, F. Borja, Guzmán, Yoelimar, Nogueira, Sara T., Otero-Piñeiro, Ana, Almenara, Raúl, Lacy, Antonio M.
Format: Journal Article
Language:English
Published: New York Springer US 01-12-2021
Springer Nature B.V
Subjects:
2020 SAGES Oral
Abdominal Surgery
Aged
Cancer therapies
Colonoscopy
Colorectal cancer
Endoscopy
Gastroenterology
Gynecology
Hepatology
Humans
Laparoscopy
Magnetic resonance imaging
Male
Medicine
Medicine & Public Health
Metastasis
Neoplasm Recurrence, Local - epidemiology
Postoperative Complications
Proctology
Rectal Neoplasms - surgery
Rectum
Retrospective Studies
Surgery
Tertiary Care Centers
Transanal Endoscopic Surgery
Treatment Outcome
Tumors
Recurrence
Total mesorectal excision
TaTME
Locally advance rectal cancer
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Summary:Background For mid and low rectal cancer, transanal total mesorectal excision (TaTME) has been established as an alternative approach to laparoscopic surgery. However, there are concerns about an unexpected pattern of local recurrence. This study aimed to analyze the pattern of local recurrence for patients treated with TaTME in a tertiary referral center. Methods A retrospective single-center analysis was performed. Since 2011, all patients with rectal cancer undergoing TaTME with curative intent were prospectively included in a standardized database. Patients with tumors within 12 cm, clinical stage II or III were included. The primary endpoint of the study was the overall local recurrence rate, together with a critical analysis of the patterns of local failures. Results Two hundred and five patients were included in this analysis. At the time of surgery, patients had a mean age of 67.1 years (SD 12.3), and 66.8% were male. Neoadjuvant therapy was administered in 73.7%. Mesorectal specimen quality was complete or near-complete in 98.5%, while circumferential resection margin was ≤ 1 mm (including T4 tumors) in 11.8%. After a median follow-up of 34.3 months (95% CI 30.1–38.5), 3.4% ( n  = 7) presented with local recurrent disease. Six out of the seven patients were also diagnosed with hematogenous metastases. Of the seven patients, three presented with at least one of the following risk factors: T4 tumor, N2 disease, incomplete mesorectal specimen, or positive CRM. Local failure was noted posteriorly ( n  = 3), laterally ( n  = 2), anteriorly ( n  = 1), and in the axial compartment ( n  = 1). Median time to relapse was 31.5 months (10.3—40.9). The median follow-up after local recurrence was 7.9 (95% CI 6.7–9.1) months, with an overall survival of 85.7%. Conclusions TaTME provided satisfactory local recurrence outcomes, and the most common patterns of failure were in the central pelvis.
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ISSN:0930-2794
1432-2218
DOI:10.1007/s00464-020-08200-4