• Br J Surg · Aug 2020

    Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation.

    • S E van Oostendorp, H J Belgers, B T Bootsma, J C Hol, E J T H Belt, W Bleeker, F C Den Boer, A Demirkiran, M S Dunker, H F J Fabry, E J R Graaf, J J Knol, S J Oosterling, G D Slooter, D J A Sonneveld, A K Talsma, H L Van Westreenen, M Kusters, R Hompes, H J Bonjer, C Sietses, and J B Tuynman.
    • Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
    • Br J Surg. 2020 Aug 1; 107 (9): 1211-1220.

    BackgroundTransanal total mesorectal excision (TaTME) has been proposed as an approach in patients with mid and low rectal cancer. The TaTME procedure has been introduced in the Netherlands in a structured training pathway, including proctoring. This study evaluated the local recurrence rate during the implementation phase of TaTME.MethodsOncological outcomes of the first ten TaTME procedures in each of 12 participating centres were collected as part of an external audit of procedure implementation. Data collected from a cohort of patients treated over a prolonged period in four centres were also collected to analyse learning curve effects. The primary outcome was the presence of locoregional recurrence.ResultsThe implementation cohort of 120 patients had a median follow up of 21·9 months. Short-term outcomes included a positive circumferential resection margin rate of 5·0 per cent and anastomotic leakage rate of 17 per cent. The overall local recurrence rate in the implementation cohort was 10·0 per cent (12 of 120), with a mean(s.d.) interval to recurrence of 15·2(7·0) months. Multifocal local recurrence was present in eight of 12 patients. In the prolonged cohort (266 patients), the overall recurrence rate was 5·6 per cent (4·0 per cent after excluding the first 10 procedures at each centre).ConclusionTaTME was associated with a multifocal local recurrence rate that may be related to suboptimal execution rather than the technique itself. Prolonged proctoring, optimization of the technique to avoid spillage, and quality control is recommended.© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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