F. Borja DeLacy, MD1, Jacqueline van Laarhoven, MD2, Romina Pena, MD1, María Clara Arroyave, MD3, María Fernández-Hevia, MD1, Raquel Bravo, MD1, Antonio M. Lacy, MD, PhD1. 1Hospital Clinic of Barcelona, 2Jeroen Bosch Ziekenhuis, 3Clinica Somer
Introduction: Transanal total mesorectal excision (taTME) has emerged as an alternative to open and laparoscopic techniques for mid and low rectal cancer. Reports published to date concluded that it is a safe and feasible technique. However, concerns exist about procedure related complications and if there are differences with what high quality randomized trials displayed for pure laparoscopic TME (37-54%). This study shows the morbidity outcomes of the largest series published of taTME.
Methods and Procedures: We analyzed the outcomes of all patients with mid and low rectal cancer treated by taTME at our hospital. All patients were entered in a prospectively collected database.
Results: One hundred eighteen patients (63.4%) with mid rectal tumor and 68 (36.6%) with low rectal tumor undergoing taTME were identified. Mean age was 65.0 years, 118 patients (63.4%) were male and 53.4% had a BMI>25Kg/m2. The majority of patients were classified as ASA II (82.0%) and ASA III (13.7%). Preoperative staging showed T1 in 3.3%, T2 in 20.1%, T3 in 67.9% and T4 and in 7.6%. Neoadjuvant treatment was given in 67.2%. Mean operative time was 147.8 min. Splenic flexure was mobilized in 38.3%, and a diverting ileostomy was performed in 85.4% of the cases. Anastomosis was created in 98.4% of the cases, of which 31.9% were handsewn and 68.1% stapled. Intraoperative complications occurred in 14 cases (8.1%). The 30-day postoperative complications rate was 36.8%: anastomotic leakage 7.7%, intraabdominal collection 7.1%, ileus 11.5%, urinary retention 4.4% and haemorrhage 2.7%. Of these complications 26.3% were classified as minor complications (Clavien-Dindo I-II) and 9.8% were classified as major complications (Clavien-Dindo III-IV). Reintervention was needed in 14 (7.7%) cases. Mean length of hospital stay was 8 days and the readmission rate was 11.7%. The three-month mortality rate was 1.1% (n=2): due to spontaneous oesophageal perforation (n=1) and myocardial infarction in the immediate postoperative period (n=1).
Conclusion: In a high volume center for the treatment of rectal cancer, the morbidity following taTME is similar to the one following pure laparoscopic TME.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80239
Program Number: P004
Presentation Session: Poster of Distinction (Non CME)
Presentation Type: PDIST