Transanal Total Mesorectal Excision(TaTME) for Rectal Cancers: Short and mid term results

Abstract

BACKGROUND: Colorectal cancer is the 3rd most common cancer affecting males and females in most western countries and is leading cause of cancer related deaths. The primary goal of surgery is complete removal of rectal cancer.Total Mesorectal Excision (TME) is the cornerstone of curative therapy for rectal adenocarcinoma. Transanal total mesorectal excision (TaTME) was introduced for mid and lower rectal cancer and is proposed to allow a precise mesorectal dissection through better visualization in anatomically limited pelvis.

OBJECTIVES: To check the feasibility of Trans anal Total Mesorectal Excision (TaTME) in terms of:-  Quality of TME, Circumferential resection margin positivity, Lymph node yield, Operation time, Mean blood loss, Post operative complications, Conversion rate, Hospital stay.

METHODS: This  was an observational  study from July 2018 to June 2020 for 2 years, to validate the efficacy of TaTME in our setup. It included Biopsy proven low and mid rectal cancers(4-8 cms) from anal verge &T1with node positive disease and all T2,T3 with or with out nodal disease. Statistical analysis was done by using spss software v24

RESULTS: Out of the total patients studied (35), 30 were males and the rest 5 patients were females. Patients received neoadjuvant therapy(14) and 21 patients didn’t receive. 30 of them have complete mesorectal excision, 4 patients have near complete mesorectal excision & 1 had poor excision. 25 were having moderately differentiated adenocarcinoma,7  had poorly differentiated adenocarcinoma and 3 had well differentiated adenocarcinoma. 34 patients had normal distal resection margin and only 1 had positive distal resection margin. only 2  patients was having positive circumferential resection margin while rest of 33 patients  CRM was normal. The mean average of the tumor distance from anal verge was 4.97 cm with minimum 3cm and maximum7cm. The mean average of lymph node yield was 7.86 with minimum  5 and maximum 11. The average mean of operation time was 2.095 hours with maximum time 3.5 hours and minimum  1.3 hours. Postop complications, at 1 MONTH 25 patients with no post op complications at 1 month (71.4%),3 patients with UTI(8.6%), Surgical site infections in 2 patients(5.7%),  AKI  in 1(2.9%), Anastamotic leak in1(2.9%), Incontinence in 1 (2.9%), stromal retraction in 1 (2.9%) and recto vaginal fistula in 1 (2.9%) patient. At 3 months: Out of the total patient studied, 31 patients were having no complication  followed by Sub acute intestinal obstruction in 2(5.7%) and sexual dysfunction in 2 patients(5.7%).

CONCLUSION: The present study suggest that Transanal TME is a feasible method for oncologic resection of locally advanced mid- and distal-rectal cancer with curative intent. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications are very satisfactory. Short-term morbidity and oncologic outcomes are as good as in other laparoscopic TME series. It also concluded that taTME allow wide resection margin and good quality total mesorectal excision. In addition, TaTME showed a better short-term clinical outcomes, such as a longer CRM, lower risk of positive CRM, higher complete quality of TME rate, and shorter operative duration.