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An international mu...
An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)
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- Buchwald, Pamela (creator_code:cre_t)
- Lund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups
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Minaya-Bravo, ABAM (author)
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Gallo, G (author)
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Glasbey, JC (author)
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Kamarajah, S (author)
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Nepogodiev, D (author)
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Pinkney, T (author)
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El-Hussana, A (author)
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(creator_code:org_t)
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- 2018-09-25
- 2018
- English.
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In: Colorectal Disease. - : Wiley. - 1462-8910. ; 2020 Suppl 6, s. 33-46
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Abstract
Subject headings
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- INTRODUCTION: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.RESULTS: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P = 0.39 and OR 2.11, 0.79-5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P < 0.001) and male gender (OR 2.29, 1.52-3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.CONCLUSION: This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Aged
- Elective Surgical Procedures/methods
- Female
- Humans
- Laparoscopy/methods
- Male
- Margins of Excision
- Medical Audit
- Middle Aged
- Operative Time
- Postoperative Complications/etiology
- Proctectomy/methods
- Prospective Studies
- Rectal Neoplasms/surgery
- Rectum/surgery
- Robotic Surgical Procedures/methods
- Transanal Endoscopic Surgery/methods
- Treatment Outcome
Publication and Content Type
- art (subject category)
- ref (subject category)
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