Soterios George Panousopoulos*, Panayiotis Lazarides, Georgios Panousis, Doukakis Paradellis, Nikolaos Boltsis and Constantinos Mavrantonis

6^th Surgical Department, Hygeia Hospital, Athens, Greece

*Corresponding Author: Soterios George Panousopoulos, 6th Surgical Department, Hygeia Hospital, Athens, Greece.

Received: April 30, 2021; Published: May 17, 2021

Citation: Soterios George Panousopoulos., et al. “Specimen Quality of Transanal Total Mesorectal Excision (TaTME)". Acta Scientific Gastrointestinal Disorders 5.6 (2021): 48-50.

Abstract

Introduction: Total mesorectal excision of the rectum (TME), has been the gold standard of rectal cancer treatment since its introduction in the 1980s, greatly improving oncologic outcomes for rectal cancer patients. Minimally invasive adapatations of TME have proved to be non-inferior to the open technique. For tumors of the distal third of the rectum, however, TME continues to present significant difficulty. The advent of transanal surgery has led to Transanal Total Mesorectal Excision (TaTME), in an effort to better facilitate complete excision, while preserving the desired oncologic results.

Aim: In this study we present our experience with TaTME in 52 cases of rectal cancer patients, who were treated at our department.

Patients and Methods: Between March 2018 and December 2020, 52 patients underwent TaTME for rectal cancer, performed by a single surgeon and surgical team. Pathology reports were compared to those of 48 patients who underwent laparoscopic TaSE TME by the same team between 2012 and 2019. Circumferential Resection Margin (CRM), and completeness of TME, were considered.

Results: Combined, in the TaTME group, “complete” and “nearly complete” TME specimens were documented in 92.3% of cases. In the TaSE group, the combined “complete” and “nearly complete” specimens were 89.6% (no statistical significance- p = 0.804844). In the CRM involvement investigation, pathology reported 46 cases (88.5%) of free CRM, and 6 cases (11.5%) of involved CRM in the TaTME group (n = 52). In the TaSE group (n = 48), there were 41 cases (85.4%) of free CRM and 7 cases (14.6%) of involved CRM (no statistical significance- p = 0.678986).

Conclusion: Our experience with TaTME shows that it is an acceptable TME procedure, delivering excellent results as far as operative quality is concerned. Although hampered by a steep learning curve, it seems that TaTME is safe and efficient enough when performed in a specialized setting, and at least non-inferior to other TME approaches as far as specimen quality is concerned.

Keywords: TaTME; Transanal TME; Rectal Cancer; TME Specimen Grading; TME; Total Mesorectal Excision

Bibliography

1. Heald R., et al. “The mesorectum in rectal cancer surgery–the clue to pelvic recurrence?” British Journal of Surgery 69 (1982): 613-616.
2. Heald R. “The ‘Holy Plane’ of rectal surgery”. Journal of the Royal Society of Medicine 81 (1988): 503-508.
3. Jayne D., et al. “Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial”. The Journal of the American Medical Association 318 (2017): 1569-1580.
4. Stevenson A., et al. “Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the australasian laparoscopic cancer of the rectum randomized clinical trial”. Annals of Surgery 269 (2019): 596-602.
5. Fleshman J., et al. “Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial”. Annals of Surgery 269 (2019): 589-595.
6. Fleshman J., et al. “Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial”. The Journal of the American Medical Association 314 (2015): 1346-1355.
7. Van Der Pas M., et al. “Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial”. The Lancet Oncology 14 (2013): 210-218.
8. Jeong S., et al. “Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial”. The Lancet Oncology 15 (2014): 767-774.
9. Sylla P., et al. “NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance”. Surgical Endoscopy 24 (2010): 1205-1210.
10. Veltcamp Helbach M., et al. “Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases”. Surgical Endoscopy 30 (2016): 464-470.
11. Burke J., et al. “Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients”. Colorectal Disease 18 (2016): 570-577.
12. Chen C., et al. “Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study”. Annals of Surgical Oncology 23 (2016): 1169-1176.
13. Quirke P., et al. “Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision”. Lancet 2 (1986): 996-999.
14. Campa-Thompson M., et al. “Pathologic processing of the total mesorectal excision”. Clinics in Colon and Rectal Surgery1 (2015): 43-52.
15. Song SB., et al. “The quality of total mesorectal excision specimen: A review of its macroscopic assessment and prognostic significance”. Chronic Diseases and Translational Medicine1 (2018): 51-58.

Copyright: © Soterios George Panousopoulos., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.