Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes

Sapho Xenia Roodbeen, Marta Penna, Hugh Mackenzie, Miranda Kusters, Andrew Slater, Oliver M Jones, Ian Lindsey, Richard J Guy, Chris Cunningham, Roel Hompes, Sapho Xenia Roodbeen, Marta Penna, Hugh Mackenzie, Miranda Kusters, Andrew Slater, Oliver M Jones, Ian Lindsey, Richard J Guy, Chris Cunningham, Roel Hompes

Abstract

Background: While a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI.

Methods: From June 2013, all consecutive TaTME cases were included and compared to lapTME in a single institution. Propensity score-matching was performed for nine relevant factors. Primary outcome was resection margin involvement (R1), secondary outcomes included intra- and post-operative outcomes.

Results: After matching, forty-one patients were included in each group; no significant differences were observed in patient and tumor characteristics. The resection margin was involved in 5 cases (12.2%) in the laparoscopic group, versus 2 (4.9%) TaTME cases (P = 0.432). The TME specimen quality was complete in 84.0% of the laparoscopic cases and in 92.7% of the TaTME cases (P = 0.266). Median distance to the circumferential resection margin (CRM) was 5 mm in lapTME and 10 mm in TaTME (P = 0.065). Significantly more conversions took place in the laparoscopic group, 9 (22.0%) compared to none in the TaTME group (P < 0.001). Other clinical outcomes did not show any significant differences between the two groups.

Conclusion: This is the first study to compare results of TaTME with lapTME in a highly selected patient group with MRI-defined low rectal tumors. A significant decrease in R1 rate could not be demonstrated, although conversion rate was significantly lower in this TaTME cohort.

Keywords: CRM; Conversion; Laparoscopic TME; MRI; Minimal Invasive Surgery; Rectal cancer; Transanal TME.

Conflict of interest statement

Sapho Roodbeen, Marta Penna, Hugh Mackenzie, Miranda Kusters, Andrew Slater, Oliver Jones, Ian Lindsey, Richard J. Guy, Chris Cunningham, and Roel Hompes have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
MRI definition of a low rectal tumor (sagittal (left) and coronal (right) T2 MRI-scans showing the line between the pubic bone and the origin of the levator muscles: a tumor below this line was defined as a low rectal cancer)

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