Transanal total mesorectal excision for rectal cancer has been suspended in Norway
Top Cited Papers
Open Access
- 5 December 2019
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 107 (1), 121-130
- https://doi.org/10.1002/bjs.11459
Abstract
Background Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan–Meier estimates were used to compare local recurrence. Results In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7·6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2·4 years was 11·6 (95 per cent c.i. 6·6 to 19·9) per cent after TaTME compared with 2·4 (1·4 to 4·3) per cent in the NCCR (P < 0·001). The adjusted hazard ratio was 6·71 (95 per cent c.i. 2·94 to 15·32). Anastomotic leaks resulting in reoperation occurred in 8·4 per cent of patients in the TaTME cohort compared with 4·5 per cent in NoRGast (P = 0·047). Fifty‐six patients (35·7 per cent) had a stoma at latest follow‐up; 39 (24·8 per cent) were permanent. Conclusion Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.Funding Information
- Medtronic®
This publication has 36 references indexed in Scilit:
- Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal CancerAnnals of Surgery, 2019
- Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancerSurgical Endoscopy, 2018
- Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic OutcomesJAMA, 2015
- Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical TrialJAMA, 2015
- A Randomized Trial of Laparoscopic versus Open Surgery for Rectal CancerThe New England Journal of Medicine, 2015
- Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trialThe Lancet Oncology, 2014
- Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trialThe Lancet Oncology, 2010
- NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistanceSurgical Endoscopy, 2010
- Can We Predict Immediate Outcome After Laparoscopic Rectal Surgery? Multivariate Analysis of Clinical, Anatomic, and Pathologic Features After 3-Dimensional Reconstruction of the Pelvic AnatomyAnnals of Surgery, 2008
- Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resectionInternational Journal of Colorectal Disease, 2008