Anthony P D’andrea, MD, MPH1, Jordan M Cuevas, BS1, Deepika Bhasin, MPH1, Antoinette Bonaccorso, MD1, Motahar Basam, MD2, Vikram Attaluri, MD2, Elisabeth Mclemore, MD2, Randolph M Steinhagen, MD1, Patricia Sylla, MD1. 1Division of Colorectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 2Department of Surgery, Los Angeles Medical Center, Southern California Kaiser Permanente Medical Group
Background: taTME has become increasingly adopted in the surgical management of low rectal cancer, but the reported experience in the US is limited.
Methods: We conducted an IRB-approved retrospective analysis of a prospective cohort of patients undergoing taTME for rectal cancer at two tertiary care hospitals in the US between 2014 and 2018. All transanal procedures were performed by one surgeon at each institution who had performed ≥50 taTME procedures prior to the study period. Demographic, perioperative, and follow-up data were analyzed.
Results: Of 49 consecutive taTME patients, males comprised 71% with average age 57 years (37-89) and BMI 27.5 kg/m2 (17.3-47.2). Tumor height was ≤5 cm in 37%, >5-10 cm in 59% and >10 cm from the anal verge in 4%. Tumors were stage I in 7 (14%), II in 11 (22%), III in 28 (57%) and IV in 3 (6%), including local recurrences following prior LAR in 2 patients. Neoadjuvant treatment +/- additional chemotherapy was administered in 43 (88%). Tumors were restaged by MRI in 28 (65%) with downstaging documented in 25 (89%). Procedures consisted in LAR in 44 (90%), APR in 4 (8%) and total proctocolectomy in 1 patient (2%). A 2-team approach was used in 94% of cases with laparoscopic (85%) or robotic abdominal assistance (15%). Transanal platforms included TAMIS (49%) and TEO (51%). Intersphincteric resection was required in 9 (18%) cases with 59% handsewn and 41% stapled anastomoses all completed with a loop ileostomy. There were 5 (10%) abdominal conversions to open. Median LOS was 5 days (2-16). Two mortalities (4%) resulted from ARDS and pulmonary embolism, with a 30-day morbidity rate of 43% (15 Clavien-Dindo Grade I-II, 6 Grade III-V complications). TME grading was complete or near complete in 47 (96%) cases with an average of 13.4 lymph nodes (0-44). CRM was positive in 1 patient (2%) later salvaged with APR. At a median follow-up of 8 months (1-42), ileostomies were reversed in 59% with median time to reversal of 6 months (1-15). Local and distant recurrences occurred in 3 (6%) and 2 (4%) patients respectively. Overall survival is 96%.
Conclusion: When performed by surgeons beyond their learning curve and at centers of expertise, taTME has become the preferred approach for low rectal cancer, even for tumors at ≤5 cm, BMI >45, and select cases of local recurrences, as it permits high rates of sphincter preservation with good oncologic outcomes and acceptable morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96051
Program Number: S061
Presentation Session: Colorectal II – Neoplasia
Presentation Type: Podium