Early Experience With Transanal Total Mesorectal Excision Compared With Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Propensity Score-Matched Analysis

BACKGROUND: Laparoscopic total mesorectal excision is widely used for rectal cancers; however, it is sometimes challenging, especially in obese patients with low tumors, particularly after chemoradiotherapy. Transanal total mesorectal excision was developed to overcome these limitations in terms of visualization, dissection, and stapling. OBJECTIVE: The purpose of this study was to compare the pathologic and early oncologic outcomes of the laparoscopic and transanal approaches. DESIGN: This was a retrospective comparative study using propensity score–matched analysis. SETTING: The study was conducted at a tertiary hospital specializing in oncology. PATIENTS: In total, 722 inpatients who underwent total mesorectal excision for rectal cancer from January 2014 to December 2017 were included. INTERVENTIONS: Laparoscopic (N = 514) and transanal (N = 208) total mesorectal excision were performed. MAIN OUTCOME MEASURES: The primary outcome was pathologic outcome including circumferential and distal resection margin involvement. The secondary outcomes were intraoperative and postoperative complications and overall survival, recurrence-free survival, and local recurrence rates. RESULTS: The 2 groups of the cohort had several differences; thus, we performed propensity score matching. The circumferential resection margin was involved in 13.4% and 12.9% of the laparoscopic and transanal groups (p = 0.88). The distal resection margin was involved in 1% and 3% of t...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research