Laparoscopic Transanal Abdominal Transanal (tata) Resection with Sphincter Preservation for Rectal Cancer of the Distal 3cm Following Neoadjuvant Therapy

Introduction: In a prospective rectal cancer management program, this study reports short and long term results of laparoscopic radical transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) after neoadjuvant therapy.

Methods: From 1998 to 2008, in a prospective database, 102 rectal cancer patients were treated with laparoscopic TATA. Patients with distant metastasis at presentation, tumor > 3cm from the anorectal ring, and those not undergoing neoadjuvant therapy were excluded leaving 79 patients for this study. Demographics are as follows: gender: 54 men, 25 women; Mean age: 59.2 years (22-85). Thirteen patients completed neoadjuvant therapy prior to original evaluation and are excluded from report of initial clinical assessment. Pretreatment T Stage was as follows: T3=50, T2=16. Mean level in rectum superior to anorectal ring: 1.2cm (-0.5-3.0); Fixity of tumor: mobile=31, tethered=27, early fixation=8; Ulceration: none=8, minimal=12, superficial=7, moderate=22, deep=27; Mean pretreatment size of tumor: 4.8cm (1.5-12.0); External beam radiation: median=5400cGy (3000-7295); 75 with chemo.

Results: Mean follow up was 34.2 mos (1.9-113.9 mos). There were no perioperative mortalities. The conversion rate was 2.5%. The mean largest incision length was 4.3cm (1.2-21cm). In 84% of the patients the incision was < 6.0cm and 46% of the patients had no abdominal incision to deliver the specimen. Mean EBL was 367cc (75cc-2200cc). All patients had a temporary diverting stoma. Major morbidities were 11% with a 21.5% minor morbidity rate. Major complications included: 4 full thickness rectal prolapse with repair, 1 ischemic neorectum with successful reanastomosis, 2 bowel obstructions and 2 failed anastomosis requiring stoma. ypT Stage are as follows: complete response=22, ypT1=12, ypT2=22, ypT3=23; ypN0=65, ypN+=14 (T3=7, T2=4, T1=3). Local recurrence (LR)=2.5% (2/79). Distant metastases rate of 10.1% (8/79). Both local recurrences had synchronous distant metastases. KM5YAS = 97.1%. Overall 90% of patients lived without a stoma. Neorectal loss due to L/R followed by APR=2, ischemic=2, 3 were not reversed due to comorbidities, 1 had a stoma secondary to bowel obstruction.

Conclusion: Our results indicate excellent L/R rates and 5 year survival without the need for permanent colostomy in patients with cancers in the distal 1/3 of the rectum. Laparoscopic TME in the transanal abdominal transanal (TATA) approach is safe and can be completed laparoscopically an overwhelming percentage of the time. Multi-institutional studies will be required to establish the reproducibility of this promising approach.

Session: Podium Presentation

Program Number: S004

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