Vol. 99 No. 3 (2020), Original article
Vol. 99 No. 3 (2020)

Our experience with transanal total mesorectal excision (TaTME) procedures with middle and distal rectal tumors

Original article
Published 2020-03-30
Vladimír Procházka
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
Tomáš Grolich
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
Martina Farkašová
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
Vladimír Čan
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
Roman Svatoň
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
Martin Svoboda
Faculty of Medicine, Masaryk University, Brno
Lenka Ostřížková
Internal hematology and oncology clinic, Faculty of Medicine, Masaryk University, University Hospital Brno
Michal Eid
Internal hematology and oncology clinic, Faculty of Medicine, Masaryk University, University Hospital Brno
Lukáš Frola
Department of pathology, Faculty of Medicine, Masaryk University, University Hospital Brno
Šárka Bohatá
Clinic of radiology and nuclear medicine, Faculty of Medicine, Masaryk University, University Hospital Brno
Zdeněk Kala
Department of Surgery, Faculty of Medicine, Masaryk University, University Hospital Brno
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Keywords

rectal cancer
transanal total mesorectal excision
circumferencial resection margin
complications

Abstract

Introduction: Transanal total mesorectal excision (TaTME) is a relatively new approach in surgical treatment of rectal cancer. There are no clear indications when to choose this strategy. It is a technically demanding procedure for the surgeon with a long learning curve, which should also be taken into account in evaluation of this method. The results of both oncological and postoperative complications must be properly evaluated to explore the benefit of TaTME. The aim of this study is to assess the potential benefit of TaTME compared to other alternatives in middle and distal rectal tumors.
Methods: Retrospective evaluation of patients undergoing TaTME procedure performed by one team of surgeons between October 2014 and June 2019. The authors analyzed demographic indicators of the group of patients, tumor characteristics, specimen quality, early postoperative complications and the possibility of stoma reversal.
Results: A total of 93 patients underwent TaTME procedure for middle and distal rectal cancer. Mean BMI was 27.6 (4.8). T3 or T4 tumor was found in 73 (78.5%) patients, 68 (73.1%) patients had positive lymph nodes and 12 (12.9%) patients were treated for synchronous metastatic rectal cancer. Neoadjuvant therapy was used in 80 (86%) patients. Conversion to open laparotomy was necessary in one case (1%). Stapled anastomosis was performed in 37 (39.7%) cases, handsewn in 56 (60.2%). A positive circumferential resection margin (CRM) was found in 10 (10.7%) cases. Distal resection margin (DRM) was positive in 3 (3.2%) patients...

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