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Trans-anal surgery with the taTME technique for rectal gastrointestinal stromal tumors: a retrospective study

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Abstract

Purpose

Rectal gastrointestinal stromal tumors (GISTs) surgery is often challenging owing to the anatomical constraints of the narrow pelvis and tumor hugeness. Despite the increasing number of patients undergoing trans-anal total mesorectal excision (taTME) globally, the feasibility of trans-anal surgery with the taTME technique for rectal GISTs remains unclear. We aimed to evaluate the feasibility of trans-anal surgery with the taTME technique for rectal GISTs.

Methods

Using a prospectively collected database, we retrospectively analyzed the clinical findings, surgical outcomes, pathological outcomes, urinary and anal functions, and prognoses of patients who underwent trans-anal surgery with the taTME technique for primary rectal GISTs at the National Cancer Center Hospital East from September 2014 to March 2020.

Results

Twenty-one patients with primary rectal GISTs were included in this study. The median distance from the anal verge to the lower edge of the tumor was 40 mm (range, 15–60 mm), and the median tumor size was 59 mm (range, 11–175 mm). Moreover, seven and 14 patients underwent one-team and two-team surgeries, respectively, with curative intent. Nineteen patients (90.5%) underwent anus-preserving surgery, and the urinary tracts were preserved in all cases. Two-team surgery showed a significantly lower blood loss volume and shorter operation time than one-team surgery (58 vs. 222 mL, P = 0.017; 184 vs 356 min, P = 0.041, respectively). The pathological negative-margin resection rate was 100%. During the follow-up period, no patient developed local GIST recurrence and one (4.8%) developed distant metastasis.

Conclusion

Trans-anal surgery with the taTME technique is feasible for rectal GISTs, and two-team surgery may be more advantageous than one-team surgery in terms of operation time and blood loss.

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Data sharing and accessibility

The datasets generated and analyzed during the present study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the staff of the National Cancer Center Hospital East, Kashiwa, Japan.

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Takahiro Shigaki, Yuichiro Tsukada, Koichi Teramura, Hiro Hasegawa, Koji Ikeda, Yuji Nishizawa, Takeshi Sasaki & Masaaki Ito

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  1. Takahiro Shigaki
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  2. Yuichiro Tsukada
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  3. Koichi Teramura
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  4. Hiro Hasegawa
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  7. Takeshi Sasaki
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  8. Masaaki Ito
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Takahiro Shigaki, Yuichiro Tsukada, and Masaaki Ito. The first draft of the manuscript was written by Takahiro Shigaki, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masaaki Ito.

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Ethics approval and consent to participate

This study was conducted in accordance with the provisions of the Declaration of Helsinki and approved by the institutional ethics review board of the National Cancer Center Hospital East, Japan (approval no. 2018–100). We applied opt-out method to obtain consent on this study using the document that was approved by the institutional review board.

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Shigaki, T., Tsukada, Y., Teramura, K. et al. Trans-anal surgery with the taTME technique for rectal gastrointestinal stromal tumors: a retrospective study. Int J Colorectal Dis 37, 1975–1982 (2022). https://doi.org/10.1007/s00384-022-04233-4

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