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Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study

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Abstract

Background

Transanal TME (TaTME) was introduced to improve access to the pelvis in difficult cases (male sex, obesity and mid to low rectal cancers) and reduce the risk of anastomotic leak by avoiding cross stapling. In April 2018 the Norwegian hospital to whom all local; recurrences for rectal cancer are referred reported an unexpected rise in early multifocal local recurrences of 9.5% following TaTME compared with 3.4% following conventional TME leading to a nationwide moratorium on the procedure and ending, in an editorial published on the British Journal of Surgery in August 2020, by saying that other countries should consider the issue in the context of local practices and results. There are limited data concerning oncological outcomes of TaTME compared to conventional TME. The aim of this study was to report perioperative and oncological outcomes for patients with rectal cancer treated with TaTME in a high-volume, experienced UK centre.

Methods

From January 2015 to January 2020 consecutive patients with histologically confirmed rectal cancer having TaTME at Worcestershire Royal Hospital NHS were prospectively entered into an online international registry. Patients were followed according to local protocol with clinical examination, tumour markers, endoscopy and radiology.

Results

Seventy patients underwent TaTME for rectal cancer. The median distance of the tumour from the anorectal junction was 4 cm (IQR 2–5). The mesorectal margin was involved in 20 (1%) patients, all of whom received neoadjuvant chemoradiotherapy. Overall survival was 94% at a median follow-up of 15 months (IQR 9–31 months). Distant recurrence occurred in 12 (17%) of patients at a median of 14 months (IQR 10–17 months). The 18-month stoma-free survival rate was 66%.

Conclusions

A local recurrence rate of 5.7% supports the oncological safety of TaTME for rectal cancer.

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Availability of data and materials

Data are taken from the TaTME registry, an online database developed in the United Kingdom and funded by the Pelican Cancer Foundation [24]. It can be accessed via the following website (https://tatme.medicaldata.eu/).

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Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Worcestershire Acute Hospitals NHS Trust, Colorectal Surgery, Worcester, UK

    S. Hallam, F. Ahmed, N. Gouvas, S. Pandey & D. Nicol

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  1. S. Hallam
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  2. F. Ahmed
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Contributions

DN and SH were involved in study design. SH, FA, and NG collected the data. SH and FA analysed the data. SH and FA wrote the paper. SH, FA, SP, and DN edited the paper.

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Correspondence to S. Hallam.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Audit and Clinical Governance Committee of the Worcestershire Acute Hospitals NHS trust. The study was performed in accordance with the ethical standards as laid down in the 1964 declaration of Helsinki and its later amendments.

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Informed consent as this was a retrospective observational study, formal informed consent was not required.

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Hallam, S., Ahmed, F., Gouvas, N. et al. Oncological outcomes and stoma-free survival following TaTME, a prospective cohort study. Tech Coloproctol 25, 439–447 (2021). https://doi.org/10.1007/s10151-020-02390-8

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