Advertisement

Surgical Endoscopy

, Volume 32, Issue 5, pp 2442–2447 | Cite as

Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer

  • F. Borja de Lacy
  • Jacqueline J. E. M. van Laarhoven
  • Romina Pena
  • María Clara Arroyave
  • Raquel Bravo
  • Miriam Cuatrecasas
  • Antonio M. Lacy
Article

Abstract

Background

Transanal total mesorectal excision (TaTME) seems to be a valid alternative to the open or laparoscopic TME. Quality of the TME specimen is the most important prognostic factor in rectal cancer. This study shows the pathological results of the largest single-institution series published on TaTME in patients with mid and low rectal cancer.

Methods

We conducted a retrospective cohort study of all consecutive patients with rectal cancer, treated by TaTME between November 2011 and June 2016. Patient data were prospectively included in a standardized database. Patients with all TNM stages of mid (5–10 cm from the anal verge) and low (0–5 cm from the anal verge) rectal cancer were included.

Results

A total of 186 patients were included. Tumor was in the mid and low rectum in, respectively, 62.9 and 37.1%. Neoadjuvant chemoradiotherapy was given in 62.4%, only radiotherapy in 3.2%, and only chemotherapy in 2.2%. Preoperative staging showed T1 in 3.2%, T2 in 20.4%, T3 in 67.7%, and T4 in 7.5%. Mesorectal resection quality was complete in 95.7% (n = 178), almost complete in 1.6% (n = 3), and incomplete in 1.1% (n = 2). Overall positive CRM (≤ 1 mm) and DRM (≤ 1 mm) were 8.1% (n = 15) and 3.2% (n = 6), respectively. The composite of complete mesorectal excision, negative CRM, and negative DRM was achieved in 88.1% (n = 155) of the patients. The median number of lymph nodes found per specimen was 14.0 (IQR 11–18).

Conclusions

The present study showed good rates regarding total mesorectal excision, negative circumferential, and distal resection margins. As the specimen quality is a surrogate marker for survival, TaTME can be regarded as a safe method to treat patients with rectal cancer, from an oncological point of view.

Keywords

Rectal cancer Total mesorectal excision Transanal TME Circumferential resection margin Mesorectal resection quality 

Notes

Compliance with ethical standards

Disclosure

Dr Antonio M. Lacy reports personal fees from Medtronic, Olympus, Applied Medical, and Conmed, outside the submitted work. Drs F. Borja de Lacy, Dr Jacqueline JEM van Laarhoven, Drs María Clara Arroyave, Drs Raquel Bravo, and Dr Miriam Cuatrecasas have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482CrossRefPubMedGoogle Scholar
  2. 2.
    Kapiteijn E, Marijnen CA, Colenbrander AC, Klein Kranenbarg E, Steup WH, van Krieken JH, van Houwelingen JC, Leer JW, van de Velde CJ (1998) Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands. Eur J Surg Oncol 24:528–535CrossRefPubMedGoogle Scholar
  3. 3.
    Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumor spread and surgical excision. Lancet 2:996–999CrossRefPubMedGoogle Scholar
  4. 4.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646CrossRefPubMedGoogle Scholar
  5. 5.
    Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study Group (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 351:1731–1740CrossRefPubMedGoogle Scholar
  6. 6.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative (2016) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg.  https://doi.org/10.1097/SLA.0000000000001948 Google Scholar
  7. 7.
    Francis N, Penna M, Mackenzie H, Carter F, Hompes R, International TECG (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 31:2711–2719CrossRefPubMedGoogle Scholar
  8. 8.
    Deijen CL, Tsai A, Koedam TWA, Veltcamp Helbach M, Sietses C, Lacy AM, Bonjer HJ, Tuynman JB (2016) Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 20(12):811–824.  https://doi.org/10.1007/s10151-016-1545-0 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    American Joint Committee on Cancer (2010) 7th Edition Cancer Staging Manual. New York: Springer. ISBN 978-0-387-88440-0CrossRefGoogle Scholar
  10. 10.
    Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261(2):221–227CrossRefPubMedGoogle Scholar
  11. 11.
    Trépanier JS, Fernandez-Hevia M, Lacy AM (2016) Transanal total mesorectal excision: surgical technique description and outcomes. Minim Invasive Ther Allied Technol 25(5):234 – 40CrossRefPubMedGoogle Scholar
  12. 12.
    Arroyave MC, DeLacy FB, Lacy AM (2016) Transanal total mesorectal excision (TaTME) for rectal cancer: step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol.  https://doi.org/10.1016/j.ejso.2016.10.024 PubMedGoogle Scholar
  13. 13.
    Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. Am Coll Surg 221:415e423CrossRefGoogle Scholar
  14. 14.
    Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734CrossRefPubMedGoogle Scholar
  15. 15.
    Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, O’Donoghue DP, Moriarty M, Fennelly D, Sheahan K (2005) Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 47(2):141–146CrossRefPubMedGoogle Scholar
  16. 16.
    Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C (2013) Low rectal cancer: classification and standardization of surgery. Dis Colon Rectum 56:560–567CrossRefPubMedGoogle Scholar
  17. 17.
    Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TK, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim SH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645CrossRefPubMedGoogle Scholar
  18. 18.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WCJ, Bonjer HJ, COLOR II Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218CrossRefPubMedGoogle Scholar
  19. 19.
    Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PWT, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes. The ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs Open resection on pathological outcomes in rectal cancer. ALaCaRT Randomized Clin Trial JAMA. 314(13):1356–1363Google Scholar
  21. 21.
    Hasegawa A, Hida K, Kawada K, Sakai Y (2016) Transanal total mesorectal excision for rectal cancer: a video demonstration of rectal dissection. Dis Colon Rectum 59(2):157.  https://doi.org/10.1097/DCR.0000000000000474 CrossRefPubMedGoogle Scholar
  22. 22.
    Mezhir JJ, Smith KD, Fichera A, Hart J, Posner MC, Hurst RD. (2005) Presence of distal intramural spread after preoperative combined-modality therapy for adenocarcinoma of the rectum: what is now the appropriate distal resection margin? Surgery 138(4):658–663 (discussion 663–664)CrossRefPubMedGoogle Scholar
  23. 23.
    Guillem JG, Chessin DB, Shia J, Suriawinata A, Riedel E, Moore HG, Minsky BD, Wong WD (2007) A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg 245(1):88–93CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Salerno G, Daniels IR, Brown G (2006) Magnetic resonance imaging of the low rectum: defining the radiological anatomy. Colorectal Dis Suppl 3:10–13CrossRefGoogle Scholar
  25. 25.
    Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • F. Borja de Lacy
    • 1
  • Jacqueline J. E. M. van Laarhoven
    • 2
  • Romina Pena
    • 1
  • María Clara Arroyave
    • 3
  • Raquel Bravo
    • 1
  • Miriam Cuatrecasas
    • 4
  • Antonio M. Lacy
    • 1
  1. 1.Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, AIS ChannelHospital Clínic BarcelonaBarcelonaSpain
  2. 2.Department of Gastrointestinal Surgery, AIS ChannelJeroen Bosch Ziekenhuis‘s-HertogenboschThe Netherlands
  3. 3.Department of Surgical Oncology, AIS ChannelClinica SomerRionegroColombia
  4. 4.Department of Pathology, Institute of Biomedical Diagnostic Center, AIS ChannelHospital Clínic BarcelonaBarcelonaSpain

Personalised recommendations