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05.02.2020 | original article

Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision

verfasst von: María Labalde Martínez, MD PhD EBSQ Coloproctology, Francisco Javier García Borda, MD PhD, Juan Alcalde Escribano, MD PhD, Cristina Nevado García, MD PhD, Eduardo Rubio González, MD PhD, Oscar García Villar, MD PhD, Pablo Peláez Torres, MD PhD, Felipe de la Cruz Vigo, MD PhD, Eduardo Ferrero Herrero, MD PhD

Erschienen in: European Surgery | Ausgabe 2/2020

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Summary

Introduction

Transanal total mesorectal excision (TaTME) is an alternative technique for rectal surgery that could facilitate the mobilization and the distal transection of the rectum. Our objective was to analyze whether the presence of factors affecting the difficulty of laparoscopic total mesorectal excision (TME) could affect surgical and oncological outcomes of TaTME for mid and low rectal cancer.

Methods

20 patients (13 male, 7 female) with a mean age of 66.5 years (range 55.5–75.7) and mid–low rectal cancer were prospectively submitted to TaTME. Every TaTME procedure was performed by two teams of experienced surgeons working simultaneously. Adverse conditions for laparoscopic TME were considered to be male gender, obesity, benign prostatic hypertrophy, low rectal cancer, pT3-T4, tumor size >5 cm, and neoadjuvant therapy. These factors were matched to surgical (morbidity, operative time, conversion rate) and pathological (quality of mesorectum, circumferential resection margin) outcomes.

Results

Male gender was associated with longer operative time (285 vs. 240 min, p = 0.031). There were no significant associations among the rest of the analyzed factors complicating laparoscopic TME and pathological and surgical outcomes of TaTME. Multivariate analysis showed that male gender was independently associated with operative time (β = 0.18 OR 1.019 CI95%:1.001–1.037; p = 0.042).

Conclusion

TaTME seems to be more difficult in males but not in obesity, benign prostatic hypertrophy, low rectal cancer, pT3-T4, tumor size >5 cm, or neoadjuvant therapy. TaTME could be considered an alternative surgery for low rectal cancer in the presence of these factors affecting laparoscopic TME.
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Metadaten
Titel
Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision
verfasst von
María Labalde Martínez, MD PhD EBSQ Coloproctology
Francisco Javier García Borda, MD PhD
Juan Alcalde Escribano, MD PhD
Cristina Nevado García, MD PhD
Eduardo Rubio González, MD PhD
Oscar García Villar, MD PhD
Pablo Peláez Torres, MD PhD
Felipe de la Cruz Vigo, MD PhD
Eduardo Ferrero Herrero, MD PhD
Publikationsdatum
05.02.2020
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 2/2020
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-00626-y