Transanal Total Mesorectal Excision in Mid-Low Rectal Cancer: Evaluation of the Learning Curve and Comparison of Short-term Results With Standard Laparoscopic Total Mesorectal Excision.
Adult
Aged
Blood Loss, Surgical
/ statistics & numerical data
Case-Control Studies
Data Management
Female
Humans
Laparoscopy
/ methods
Learning Curve
Length of Stay
/ statistics & numerical data
Male
Margins of Excision
Middle Aged
Neoplasm Recurrence, Local
/ epidemiology
Neoplasm Staging
/ methods
Operative Time
Outcome Assessment, Health Care
Postoperative Complications
/ epidemiology
Proctectomy
/ methods
Rectal Neoplasms
/ diagnosis
Retrospective Studies
Transanal Endoscopic Surgery
/ methods
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
pubmed:
5
1
2021
medline:
27
8
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Ever since transanal total mesorectal excision was introduced by Sylla and Lacy in 2010, it has become more popular among colorectal surgeons. However, some surgeons hesitate to use it, because this novel approach differs greatly from laparoscopic total mesorectal excision and requires a long learning curve. This study analyzed the learning curve of transanal total mesorectal excision procedure and compared the different phases of transanal total mesorectal excision with laparoscopic total mesorectal excision. This is retrospective case-control study. We used data from the approved colorectal cancer database of the Sixth Affiliated Hospital of Sun Yat-sen University. The patients involved in this study underwent transanal total mesorectal excision performed by a single surgeon (L.K.) or underwent laparoscopic transanal total mesorectal excision performed by experienced surgeons. Transanal or laparoscopic resection of mid-low rectal cancer was conducted. Perioperative complication and resection margin were measured. A total of 342 patients were included in both groups. The learning curve of transanal total mesorectal excision was divided into 3 phases. Data show that demographics and tumor characteristics were not significantly different between the matched groups. Indeed, during phase 1, only operative time was longer than in the laparoscopic group, whereas, during phase 2, results from the transanal group were comparable with the laparoscopic group. Results show that, during phase 3, operative time, intraoperative blood loss, and postoperative hospital stay were all lower than in the laparoscopic group. Local recurrence occurred in 3 patients during phase 1 and in 1 patient during phase 2. This study was a small retrospective study and focused on just 1 surgeon performing transanal total mesorectal excision. Short-term and histopathologic outcomes are similar compared between a transanal group and matched laparoscopic group. Transanal total mesorectal excision also provided good oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/B450. ANTECEDENTES:Desde que Sylla y Lacy introdujeron la escisión mesorrectal total transanal en 2010, se ha vuelto más popular entre los cirujanos colorrectales. Sin embargo, algunos cirujanos dudan en utilizarlo, porque este nuevo método difiere mucho de la escisión mesorrectal total laparoscópica y requiere una larga curva de aprendizaje.OBJETIVO:Este estudio analizó la curva de aprendizaje del procedimiento de escisión mesorrectal total transanal y comparó las diferentes fases de la escisión mesorrectal total transanal con la escisión mesorrectal total laparoscópica.DISEÑO:Este es un estudio retrospectivo de casos y controles.ENTORNO CLINICO:Utilizamos base de datos de cáncer colorrectal aprobada del Sexto Hospital Afiliado de la Universidad Sun Yat-sen (Guangzhou, China).PACIENTES:Los pacientes involucrados en este estudio fueron sometidos a escisión mesorrectal total transanal realizada por un solo cirujano (LK) o se sometieron a escisión mesorrectal total transanal laparoscópica realizada por cirujanos experimentados.INTERVENCIONES:Resección transanal o laparoscópica de cáncer de recto medio-bajo.PRINCIPALES MEDIDAS DE VOLARCION:complicación perioperatoria y margen de resección.RESULTADOS:Se incluyó un total de 342 pacientes en ambos grupos. La curva de aprendizaje de la escisión mesorrectal total transanal se dividió en tres fases. Los datos muestran que las características demográficas y tumorales no fueron significativamente diferentes entre los grupos emparejados. De hecho, durante la fase 1, solo el tiempo operatorio fue más largo que en el grupo laparoscópico. Mientras que durante la fase 2, los resultados del grupo transanal fueron comparables a los del grupo laparoscópico. Los resultados muestran que durante la fase 3, el tiempo operatorio, la pérdida de sangre intraoperatoria y la estancia hospitalaria postoperatoria fueron menores que en el grupo laparoscópico. La recurrencia local ocurrió en 3 pacientes durante la fase 1 y en 1 paciente durante la fase 2.LIMITACIONES:Este estudio fue un estudio retrospectivo pequeño y se centró en un solo cirujano que realizaba la escisión mesorrectal total transanal.CONCLUSIÓN:Los resultados a corto plazo e histopatológicos son similares en comparación entre el grupo transanal y el grupo laparoscópico emparejado. La escisión mesorrectal total transanal también proporcionó buenos resultados oncológicos. Consulte Video Resumen en http://links.lww.com/DCR/B450.
Sections du résumé
BACKGROUND
Ever since transanal total mesorectal excision was introduced by Sylla and Lacy in 2010, it has become more popular among colorectal surgeons. However, some surgeons hesitate to use it, because this novel approach differs greatly from laparoscopic total mesorectal excision and requires a long learning curve.
OBJECTIVE
This study analyzed the learning curve of transanal total mesorectal excision procedure and compared the different phases of transanal total mesorectal excision with laparoscopic total mesorectal excision.
DESIGN
This is retrospective case-control study.
SETTINGS
We used data from the approved colorectal cancer database of the Sixth Affiliated Hospital of Sun Yat-sen University.
PATIENTS
The patients involved in this study underwent transanal total mesorectal excision performed by a single surgeon (L.K.) or underwent laparoscopic transanal total mesorectal excision performed by experienced surgeons.
INTERVENTIONS
Transanal or laparoscopic resection of mid-low rectal cancer was conducted.
MAIN OUTCOMES MEASURES
Perioperative complication and resection margin were measured.
RESULTS
A total of 342 patients were included in both groups. The learning curve of transanal total mesorectal excision was divided into 3 phases. Data show that demographics and tumor characteristics were not significantly different between the matched groups. Indeed, during phase 1, only operative time was longer than in the laparoscopic group, whereas, during phase 2, results from the transanal group were comparable with the laparoscopic group. Results show that, during phase 3, operative time, intraoperative blood loss, and postoperative hospital stay were all lower than in the laparoscopic group. Local recurrence occurred in 3 patients during phase 1 and in 1 patient during phase 2.
LIMITATIONS
This study was a small retrospective study and focused on just 1 surgeon performing transanal total mesorectal excision.
CONCLUSIONS
Short-term and histopathologic outcomes are similar compared between a transanal group and matched laparoscopic group. Transanal total mesorectal excision also provided good oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/B450.
ESCISIN MESORRECTAL TOTAL TRANSANAL EN EL CNCER DE RECTO MEDIOBAJO EVALUACIN DE LA CURVA DE APRENDIZAJE Y COMPARACIN DE RESULTADOS A CORTO PLAZO CON TME LAPAROSCPICA ESTNDAR
ANTECEDENTES:Desde que Sylla y Lacy introdujeron la escisión mesorrectal total transanal en 2010, se ha vuelto más popular entre los cirujanos colorrectales. Sin embargo, algunos cirujanos dudan en utilizarlo, porque este nuevo método difiere mucho de la escisión mesorrectal total laparoscópica y requiere una larga curva de aprendizaje.OBJETIVO:Este estudio analizó la curva de aprendizaje del procedimiento de escisión mesorrectal total transanal y comparó las diferentes fases de la escisión mesorrectal total transanal con la escisión mesorrectal total laparoscópica.DISEÑO:Este es un estudio retrospectivo de casos y controles.ENTORNO CLINICO:Utilizamos base de datos de cáncer colorrectal aprobada del Sexto Hospital Afiliado de la Universidad Sun Yat-sen (Guangzhou, China).PACIENTES:Los pacientes involucrados en este estudio fueron sometidos a escisión mesorrectal total transanal realizada por un solo cirujano (LK) o se sometieron a escisión mesorrectal total transanal laparoscópica realizada por cirujanos experimentados.INTERVENCIONES:Resección transanal o laparoscópica de cáncer de recto medio-bajo.PRINCIPALES MEDIDAS DE VOLARCION:complicación perioperatoria y margen de resección.RESULTADOS:Se incluyó un total de 342 pacientes en ambos grupos. La curva de aprendizaje de la escisión mesorrectal total transanal se dividió en tres fases. Los datos muestran que las características demográficas y tumorales no fueron significativamente diferentes entre los grupos emparejados. De hecho, durante la fase 1, solo el tiempo operatorio fue más largo que en el grupo laparoscópico. Mientras que durante la fase 2, los resultados del grupo transanal fueron comparables a los del grupo laparoscópico. Los resultados muestran que durante la fase 3, el tiempo operatorio, la pérdida de sangre intraoperatoria y la estancia hospitalaria postoperatoria fueron menores que en el grupo laparoscópico. La recurrencia local ocurrió en 3 pacientes durante la fase 1 y en 1 paciente durante la fase 2.LIMITACIONES:Este estudio fue un estudio retrospectivo pequeño y se centró en un solo cirujano que realizaba la escisión mesorrectal total transanal.CONCLUSIÓN:Los resultados a corto plazo e histopatológicos son similares en comparación entre el grupo transanal y el grupo laparoscópico emparejado. La escisión mesorrectal total transanal también proporcionó buenos resultados oncológicos. Consulte Video Resumen en http://links.lww.com/DCR/B450.
Identifiants
pubmed: 33394779
doi: 10.1097/DCR.0000000000001816
pii: 00003453-202104000-00005
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
380-388Informations de copyright
Copyright © The ASCRS 2021.
Déclaration de conflit d'intérêts
Financial Disclosure: The authors declare that they have no conflict of interest.
Références
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986; 1:1479–1482
Bonjer HJ, Deijen CL, Abis GA, et al.; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015; 372:1324–1332
van der Pas MH, Haglind E, Cuesta MA, et al.; Colorectal Cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013; 14:210–218
Jeong SY, Park JW, Nam BH, et al. 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 trial. Lancet Oncol. 2014; 15:767–774
Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010; 11:637–645
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010; 97:1638–1645
Akiyoshi T, Kuroyanagi H, Oya M, et al. Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery. 2009; 146:483–489
Ogiso S, Yamaguchi T, Hata H, et al. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc. 2011; 25:1907–1912
Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010; 24:1205–1210
Lacy AM, Tasende MM, Delgado S, et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg. 2015; 221:415–423
de Lacy FB, van Laarhoven JJEM, Pena R, et al. Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc. 2018; 32:2442–2447
Penna M, Hompes R, Arnold S, et al.; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017; 266:111–117
Heald RJ. A new solution to some old problems: transanal TME. Tech Coloproctol. 2013; 17:257–258
Marecik SJ, Pai A, Sheikh T, Park JJ, Prasad LM. Transanal total mesorectal excision: save the nerves and urethra. Dis Colon Rectum. 2016; 59:e410–e414
Deijen CL, Tsai A, Koedam TW, et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol. 2016; 20:811–824
Atallah S, Albert M. The neurovascular bundle of Walsh and other anatomic considerations crucial in preventing urethral injury in males undergoing transanal total mesorectal excision. Tech Coloproctol. 2016; 20:411–412
Shiraishi T, Nishizawa Y, Yamamoto H, Tsukada Y, Sasaki T, Ito M. Carbon dioxide embolism during transanal total mesorectal excision (taTME). Tech Coloproctol. 2018; 22:735–738
Trépanier JS, Fernandez-Hevia M, Lacy AM. Transanal total mesorectal excision: surgical technique description and outcomes. Minim Invasive Ther Allied Technol. 2016; 25:234–240
Caycedo-Marulanda A, Ma G, Jiang HY. Transanal total mesorectal excision (taTME) in a single-surgeon setting: refinements of the technique during the learning phase. Tech Coloproctol. 2018; 22:433–443
Koedam TWA, Veltcamp Helbach M, van de Ven PM, et al. Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol. 2018; 22:279–287
Yap CH, Colson ME, Watters DA. Cumulative sum techniques for surgeons: a brief review. ANZ J Surg. 2007; 77:583–586
Chang WR, McLean IP. CUSUM: a tool for early feedback about performance? BMC Med Res Methodol. 2006; 6:8
Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH; Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002; 20:1729–1734
Kang L, Chen WH, Luo SL, et al. Transanal total mesorectal excision for rectal cancer: a preliminary report. Surg Endosc. 2016; 30:2552–2562
Kim CW, Kim WR, Kim HY, et al. Learning curve for single-incision laparoscopic anterior resection for sigmoid colon cancer. J Am Coll Surg. 2015; 221:397–403
Bege T, Lelong B, Esterni B, et al. The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg. 2010; 251:249–253
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005; 242:83–91
Symer MM, Sedrakyan A, Yeo HL. Case sequence analysis of the robotic colorectal resection learning curve. Dis Colon Rectum. 2019; 62:1071–1078
Mege D, Hain E, Lakkis Z, Maggiori L, Prost À la Denise J, Panis Y. Is trans-anal total mesorectal excision really safe and better than laparoscopic total mesorectal excision with a perineal approach first in patients with low rectal cancer? A learning curve with case-matched study in 68 patients. Colorectal Dis. 2018; 20:O143–O151
Persiani R, Biondi A, Pennestrì F, et al. Transanal total mesorectal excision vs laparoscopic total mesorectal excision in the treatment of low and middle rectal cancer: a propensity score matching analysis. Dis Colon Rectum. 2018; 61:809–816
Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C. Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc. 2014; 28:3494–3499
Deijen CL, Velthuis S, Tsai A, et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc. 2016; 30:3210–3215
Roodbeen SX, Penna M, Mackenzie H, et al. Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc. 2019; 33:2459–2467
Kang L, Luo S. The crucial techniques and anatomic markers in transanal total mesorectal excision [in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. 2019; 22:220–223