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, PamelaLund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups (creator_code:cre_t)

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

Article/chapterEnglish2018

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2018-09-25
Wiley,2018

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LIBRIS-ID:oai:lup.lub.lu.se:76ba0f47-c645-4bc5-8755-b45ee8a48e02
https://lup.lub.lu.se/record/76ba0f47-c645-4bc5-8755-b45ee8a48e02URI
https://doi.org/10.1111/codi.14376DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:139264350URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype

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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 and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
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

Added entries (persons, corporate bodies, meetings, titles ...)

Minaya-Bravo, ABAM (author)
Gallo, G (author)
Glasbey, JC (author)
Kamarajah, S (author)
Nepogodiev, D (author)
Pinkney, T (author)
El-Hussana, A (author)
KirurgiForskargrupper vid Lunds universitet (creator_code:org_t)
2017 European Society of Coloproctology (ESCP) collaborating group

Related titles

In:Colorectal Disease: Wiley2020 Suppl 6, s. 33-461462-8910
In:Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland: Wiley2020 Suppl 6, s. 33-461463-1318

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By the author/editor: Buchwald, Pamela; Minaya-Bravo, AB ...; Gallo, G; Glasbey, JC; Kamarajah, S; Nepogodiev, D; show more...; Pinkney, T; El-Hussana, A; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

Articles in the publication: Colorectal Disea ...; Colorectal disea ...

By the university: Lund University; Karolinska Institutet

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