Jacqueline van Laarhoven, MD, PhD1, Borja DeLacy, MD2, Romina Pena, MD2, María Arroyave2, María Fernández-Hevia, MD1, Raúl Almenara, MD, PhD2, Antonio Lacy, MD, Professor2. 1Jeroen Bosch Ziekenhuis, 2Hospital Clinic Barcelona
Introduction: The transanal total mesorectal excision (taTME) seems to be a valid alternative to the often technical difficult performance of open or laparoscopic TME, especially in the most distal part of the pelvis. Quality of the TME specimen is the most important prognostic factor in rectal cancer. This study shows pathological results of the largest series published on 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 all stages of mid- and low rectal cancer were included in this analysis.
Results: A total of 187 patients were included in this analysis, of whom 63.1% (n=118) were male and 50.8% had a BMI of >25. Tumor was located in the mid and low rectum in respectively 63.6% and 36.4%. The mean height (cm) was 7.9 (SD 1.5) and 3.5 (SD 1.3). Neoadjuvant chemoradiotherapy was given in 62.0%, only radiotherapy in 3.2% and only chemotherapy in 2.1%. Preoperative staging showed T1 in 3.2%, T2 in 19.8%, T3 in 67.4% and T4 in 7.5%. Overall positive CRM (CRM <1 mm) was 9.6%. Postoperative pathological staging showed complete remission in 16.0%, pT1 in 6.4%, pT2 in 28.9%, pT3 in 42.8%, pT4 in 2.7% and pTis in 1.6%. Mean distal margin (cm) was 2.6 (SD 1.7) in mid rectal cancer with a positive distal resection margin in 2.5% (n=3). Mean distal margin (cm) was 1.1 (SD 1.0) in low rectal cancers with a positive distal resection margin in 7.4% (n=5). The mesorectal quality was complete in 97.3%, almost complete in 1.6% and incomplete in 1.1%. A median of 14 lymph nodes was found per specimen (IQR 11 – 18). Pathological staging showed pN0 in 64.7%, pN1 in 20.9%, pN1c in 1.6%, pN2 in 7.5% and pNx in 3.7%.
Conclusion: TaTME provided good pathological results with high rates of complete mesorectal quality and low rates of positive CRM.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80475
Program Number: S091
Presentation Session: Plenary 1
Presentation Type: Podium