Jacqueline van Laarhoven, MD, PhD1, Borja DeLacy, MD2, Romina Pena, MD2, María Arroyave, MD3, María Fernández-Hevia, MD2, Gabriel Díaz del Gobbo, MD2, Antonio Lacy, MD, Professor2. 1Jeroen Bosch Ziekenhuis, 2Hospital Clinic Barcelona, 3Clinica SOMER
Introduction: The transanal total mesorectal excision (taTME) seems to be a valid alternative to the often technical difficult performance of open or laparoscopic TME. Pathological results seem comparible to the laparoscopic or open technique. This study is one of the first studies to show oncological follow up of a large series of patients treated by taTME.
Methods and procedures: All patients with rectal cancer treated at our hospital by taTME between November 2011 and June 2016 were prospectively included in a standardized database. Patients with a minimal follow-up of 24 months were included in this analysis. High-, mid- and low rectal cancer were included in this analysis, patients with a preoperative T4 tumor were excluded. Patients periodically visited the outpatient clinic with analysis of serum carcinoembryonic antigen concentrations, colonoscopy, thoracic and abdominal computed tomography to determine recurrence of disease.
Results: A total of 90 patients were included in this analysis. At time of surgery patients had a median age of 67.5 years (range 38 – 85) and 64.4% (n=58) were male. Patients were classified as ASA I in 5.6%, ASA II in 83.3% and ASA III in 11.1%. Neoadjuvant chemoradiotherapy was administered in 56.7% (n=51) of the patients and one patient only received radiotherapy. Tumor was located in the high-, mid- and low rectum in respectively 24.4%, 52.2% and 23.3%. Postoperative pathological staging showed complete remission in 11.1%, pT1 in 8.9%, pT2 in 27.8%, pT3 in 46.7%, pT4 in 3.3%, pTis in 2.2%. Furtermore, pathological results showed N0 in 67.8%, N1 in 22.2%, N1c in 1.1% and Nx in 2.2%. CRM was <1mm in 8.9% and the mesorectal quality was complete in 98.9%.The included patients had a median follow up of 34.5 months (range 24.0 – 56.0). Of these patients 80% (n=72) had no recurrent disease, 16.7% (n=15) had recurrent disease and three patients had died with recurrent disease. Median time of overall recurrent disease was 19.5 months (range 4.0 – 37.0). A total of 15.6% of the patients had systemic recurrent disease, with a median time of 17.0 months (range 4.0 – 33.0). A total of 6.7% of the patients had locoregional recurrent disease, with a median time of 24.0 months (range 10.0 – 37.0).
Conclusion: Short term oncological outcomes after taTME are comparible to outcomes after laparoscopic TME.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80488
Program Number: P188
Presentation Session: Poster (Non CME)
Presentation Type: Poster