Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case–Control Study

• Published in: Annals of surgical oncology Vol. 23; no. 4; pp. 1169 - 1176
• Main Authors: Chen, Chien-Chih, Lai, Yi-Ling, Jiang, Jeng-Kae, Chu, Chun-Ho, Huang, I-Ping, Chen, Wei-Shone, Cheng, Andy Yi-Ming, Yang, Shung-Haur
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2016; Springer Nature B.V
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Anal Canal - surgery; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Case-Control Studies; Chemoradiotherapy, Adjuvant; Colorectal Cancer; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Oncology; Operative Time; Postoperative Complications; Prognosis; Rectal Neoplasms - drug therapy; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Transanal Total Mesorectal Excision; Circumferential Resection Margin; Lower Rectal Cancer; Rectal Cancer; Rectal Cancer Surgery
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4997-y

Background Neoadjuvant chemoradiation therapy (nCRT) has been indicated for locally advanced rectal cancer. While utilization of laparoscopy in rectal cancer surgery has been popular in recent years, tumors receiving nCRT is still a surgical challenge. Transanal total mesorectal excision (TaTME) has emerged as a focused area of laparoscopic surgery that is becoming an increasingly acceptable approach in the field of rectal surgery. Methods Between December 2013 and April 2015, a total of 50 patients (38 males) with post-nCRT middle or lower rectal cancer who then underwent TaTME at two separate institutions were prospectively documented. Overall, 100 matched control cohorts who received conventional laparoscopic rectal surgery (LapTME) were simultaneously retrieved from a prospectively registered database. Four parameters of sex, age, clinical stage, and American Society of Anesthesiologists (ASA) score were matched for surgical outcomes, and short-term oncological results, including complications and pathological outcomes, were analyzed. Results Both the TaTME and LapTME groups received 5-fluorouracil-based chemotherapy and 5 weeks of long-course radiation therapy. Mean operative time for the TaTME group was 182.1 ± 55.4 min (156.6 ± 37.8 min in two-team-approach cases) and 178.7 ± 34.8 min for the LapTME group. The TaTME group yielded longer distal margin lengths. No significant differences were observed in blood loss, intraoperative complication rate, conversion rate, anastomosis type, and free circumferential margin rate. Conclusion This matched case–control study demonstrated that TaTME is safe and feasible. Compared with LapTME, TaTME not only achieves identical circumferential margin status without compromising other operative and quality parameters but also benefits patients by achieving a longer distal margin. Thus, TaTME has the potential to become an option in managing irradiated rectal cancer.