ORIGINAL ARTICLE   

Minerva Chirurgica 2019 August;74(4):279-88

DOI: 10.23736/S0026-4733.19.08064-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

A nationwide study on the adoption and short-term outcomes of transanal total mesorectal excision in the UK

Sapho X. ROODBEEN ¹, Marta PENNA ^{2, 3}, Steve ARNOLD ⁴, Greg WYNN ⁵, Janindra WARUSAVITARNE ⁶, Nader FRANCIS ⁷, Brendan MORAN ⁴, Roel HOMPES ¹ ✉ on behalf of UK TaTME Registry Collaborative 

¹ Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; ² Department of Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK; ³ Department of Surgery and Cancer, Imperial College London, London, UK; ⁴ Department of Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK; ⁵ Department of Colorectal Surgery, Colchester Hospital University NHS Foundation Trust, Essex, UK; ⁶ Department of Colorectal Surgery, St Mark’s Hospital, Harrow, Middlesex, UK; ⁷ Department of Colorectal Surgery, Yeovil District Hospital, Yeovil, UK

BACKGROUND: The interest and adoption of transanal total mesorectal excision (TaTME) is growing worldwide, but evidence on nationwide implementation and short-term outcomes is scarce. This study aims to evaluate national results for this relatively new technique in the UK.
METHODS: All TaTME procedures performed in the UK and recorded on the international TaTME registry between January 2013 and January 2018 were analyzed. Surgeons who received training on TaTME in the UK were sent a survey regarding their experience with implementation of TaTME in their unit. Primary endpoint was a composite for “optimal pathology” (free resection margin (R0) and TME specimen with no major defects and no rectal wall perforations). Secondary outcomes included 30-day clinical course and survey outcomes.
RESULTS: Forty-two hospitals entered 513 cases over a 5-year period; 28 of 42 hospitals (66.7%) performed ten cases or less. The indication for surgery was cancer in 364 (71.0%) cases. Optimal pathology was achieved in 295 (92.8%), with an involved resection margin (R1) rate of 13 of 513 (4.1%). A Clavien-Dindo ≥III within 30 days was 13.4% (N.=45) and 6.8% (N.=10) in the cancer and benign groups, respectively. Based on the survey (response rate 68 of 86; 79%), 76.1% of the surgeons implemented TaTME in their unit after receiving training, all of whom experienced difficulties with performing TaTME.
CONCLUSIONS: This study reports acceptable nationwide short-term outcomes of TaTME. However, adoption occurred in a rapid and non-standardized manner. A structured TaTME training program is therefore recommended.

KEY WORDS: Rectal neoplasms; Minimally invasive surgical procedures; Colorectal surgery; Registries; Histology