Arman Erkan, MD, Abdul Waheed, MD, Matthew R Albert, MD, FACS, FASCRS, Justin Kelly, MD, FRCS, John R Monson, MD, FACS, FRCS, FASCRS. Surgical Health Outcomes Consortium, Florida Hospital Medical Center
Introduction: Transanal total mesorectal excision (taTME) is a novel emerging technique to facilitate pelvic dissection in low rectal lesions. This technique is still in its evolutionary phase and in the United States (US), the published data for taTME is limited to a small number of cohorts. The current study describes the largest clinical and oncological outcomes of taTME in patients with benign and malignant rectal lesions from a single institution in the US.
Methods: Data of 130 patients with benign and malignant rectal lesions from 2012 to 2017 at Florida Hospital was extracted. The primary outcome observed was the quality of TME specimen. Data was analyzed for age, gender, stage, Basal Metabolic Index (BMI), treatment, readmission, complications, type of neoadjuvant therapy and intactness of the mesorectum.
Primary endpoint: Quality of TME specimen
Secondary endpoints: Short-term patient and procedure-related adverse events.
Results: A total of 130 consecutively registered cases were analyzed comprising of 80.8% cases with rectal cancer and 19.2% with a benign pathology. 62.3% patients were male, and 37.7% were female with a mean age of 56.4 years, height 172.1 cm, weight 78.8 Kg, and BMI 26.5 Kg/m2. Almost 77.7% of patients had a previous smoking history with comorbidities including active inflammatory bowel disease (20.8%), ischemic heart disease (14.6), diabetes mellitus (12.3%), and steroid use (11.5%). The mean distance of the lesion from the anal verge was 5.0 cm (range 1-10 cm), and had a well-differentiated histology pattern (74%). Preoperative circumferential margin (CRM) involvement on MRI was 30.5% and mean CRM measured was 8.8 mm. The mean number of lymph nodes harvested were 19.1. Additionally, 94.1% of patients had lower anterior resectoin (LAR), and 5.9 % received abdominoperineal resection (APR). TME grade was complete in 79.5% of patients, nearly complete in 18.1% and incomplete in 2.4% of patients. At final pathology, the distal resection margins were negative in 99% of cases. No immediate 30-day mortality was observed. Furthermore, 13.8% patients had postoperative ileus, 9.4 % had anastomotic leak, 8.2 % developed pelvic abscess, and 3.1% suffered from urinary retention.
Conclusion: taTME is a technically feasible method in the management of benign and malignant rectal lesions. It provides an ontologically safe and effective approach for the mesorectal dissection with excellent specimen quality. Structured training and more adequately powered studies are required to assess this technique further and establish its widespread utilization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91261
Program Number: ETP851
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster