Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases
Marta Penna, Roel Hompes, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B Hanna, Neil J Mortensen, Paris P Tekkis, TaTME Registry Collaborative, Andrew Stevenson, Peter Pockney, Stephen Smith, Gerald Seitinger, Stefan Riss, Anton Stift, Markus Glöckler, Finka Jelic, Bert Houben, Joep Knol, André D'Hoore, Albert Wolthuis, Mathieu D’Hondt, Franky Vansteenkiste, Michele Grieco, Yves Van Nieuwenhove, Rodrigo Oliva Perez, Guilherme Pagin São Julião, Meyline Andrade Lima, Carlos Ramon Silveira Mendes, Tomáš Grolich, Zdeněk Kala, Jens Ravn Erikson, Jean-Jacques Tuech, Werner Kneist, Hauke Lang, Lope Estévez Schwarz, Reiner Kunz, Jörg Baral, Theo-Julian Hoffmann, Hazar Al furaji, Ronan Cahill, Alfredo Mellano, Andrea Muratore, Gabriella Capolupo, Marco Caricato, Luigi Boni, Elisa Cassinotti, Pierpaolo Sileri, Dario Borreca, Paolo De Paolis, Alberto Arezzo, Mario Morino, Emanuele Lezoche, Andrea Picchetto, Paolo Delrio, Daniela Rega, Masaaki Ito, Jae Hwan Oh, Dae Kyung Sohn, Willem Bemelman, Pieter Tanis, Jaap Bonjer, Jurriaan Tuynman, Eelco de Graaf, Pascal Doornebosch, Colin Sietses, Simone Velthuis, Edwin van der Zaag, Peter van Duijvendijk, Julian Hayes, Arend Merrie, Linus Wu, Havard Forsmo, Frank Pfeffer, Zaman Mamedli, Arsen Rasulov, Cherylin Fu Wan Pei, Vicente Simó Fernandez, Enrique Pastor Teso, Maria Fernández-Hevia, Antonio Lacy, Nicolas Christian Buchs, Frederic Ris, Daniel Geissmann, Stephan Vorburger, Ethem Gecim, Miroslava Fabryko, Yevgen Miroshnychenko, Christopher Cunningham, Oliver Jones, Ken Campbell, Sanjeev Samarasinghe, Kathryn Gill, Howard Joy, Mark Katory, Paul O’Loughlin, Neil Kukreja, Henk Wegstapel, Kamal Aryal, Roshan Lal, Arcot Venkatsubramaniam, Shazad Ashraf, Simon Radley, Marius Paraoan, Stephan Korsgen, Edward Douglas Courtney, Stephen Dalton, Andrew Allison, Nader Francis, Robin Dawson, Veera Garimella, Anthony Miles, Parvinder Sains, William Chambers, Stephen Mansfield, Irshad Shaikh, Chris Speakman, Deborah Nicol, Steve Pandey, Matthew Albert, Sam Atallah, Liliana Bordeianou, Patricia Sylla, Marta Penna, Roel Hompes, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B Hanna, Neil J Mortensen, Paris P Tekkis, TaTME Registry Collaborative, Andrew Stevenson, Peter Pockney, Stephen Smith, Gerald Seitinger, Stefan Riss, Anton Stift, Markus Glöckler, Finka Jelic, Bert Houben, Joep Knol, André D'Hoore, Albert Wolthuis, Mathieu D’Hondt, Franky Vansteenkiste, Michele Grieco, Yves Van Nieuwenhove, Rodrigo Oliva Perez, Guilherme Pagin São Julião, Meyline Andrade Lima, Carlos Ramon Silveira Mendes, Tomáš Grolich, Zdeněk Kala, Jens Ravn Erikson, Jean-Jacques Tuech, Werner Kneist, Hauke Lang, Lope Estévez Schwarz, Reiner Kunz, Jörg Baral, Theo-Julian Hoffmann, Hazar Al furaji, Ronan Cahill, Alfredo Mellano, Andrea Muratore, Gabriella Capolupo, Marco Caricato, Luigi Boni, Elisa Cassinotti, Pierpaolo Sileri, Dario Borreca, Paolo De Paolis, Alberto Arezzo, Mario Morino, Emanuele Lezoche, Andrea Picchetto, Paolo Delrio, Daniela Rega, Masaaki Ito, Jae Hwan Oh, Dae Kyung Sohn, Willem Bemelman, Pieter Tanis, Jaap Bonjer, Jurriaan Tuynman, Eelco de Graaf, Pascal Doornebosch, Colin Sietses, Simone Velthuis, Edwin van der Zaag, Peter van Duijvendijk, Julian Hayes, Arend Merrie, Linus Wu, Havard Forsmo, Frank Pfeffer, Zaman Mamedli, Arsen Rasulov, Cherylin Fu Wan Pei, Vicente Simó Fernandez, Enrique Pastor Teso, Maria Fernández-Hevia, Antonio Lacy, Nicolas Christian Buchs, Frederic Ris, Daniel Geissmann, Stephan Vorburger, Ethem Gecim, Miroslava Fabryko, Yevgen Miroshnychenko, Christopher Cunningham, Oliver Jones, Ken Campbell, Sanjeev Samarasinghe, Kathryn Gill, Howard Joy, Mark Katory, Paul O’Loughlin, Neil Kukreja, Henk Wegstapel, Kamal Aryal, Roshan Lal, Arcot Venkatsubramaniam, Shazad Ashraf, Simon Radley, Marius Paraoan, Stephan Korsgen, Edward Douglas Courtney, Stephen Dalton, Andrew Allison, Nader Francis, Robin Dawson, Veera Garimella, Anthony Miles, Parvinder Sains, William Chambers, Stephen Mansfield, Irshad Shaikh, Chris Speakman, Deborah Nicol, Steve Pandey, Matthew Albert, Sam Atallah, Liliana Bordeianou, Patricia Sylla
Abstract
Objective: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology.
Background: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population.
Methods: Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome.
Results: A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor <2 cm from anorectal junction, and laparoscopic transabdominal posterior dissection to <4 cm from anal verge.
Conclusions: TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.
Source: PubMed