This study assessed whether transanal TME in patients with rectal cancer is superior to open, laparoscopic, and robotic TME (abdominal TME (abTME)) regarding oncological outcome, postoperative morbidity and 90-day mortality.
Rectal cancer accounts for 3.8% of all new cancer diagnosis and for 3.4% of all cancer-related deaths in the world in 2020. Regarding treatment of rectal cancer, it is essential to perform surgery along the anatomical and embryological planes. This technique called total mesorectal excision (TME) reduces the local recurrence rate and improves the survival. Since the early 2000, TME has changed from open to laparoscopic approach due to better results in short-term outcome. Nevertheless, oncological benefits are modest. In 2009 the first ever transanal TME (taTME) war performed. This novel technique combines abdominal with transanal dissection. Because the distal part of the rectum is approached from below, a better visualization of the mesorectal plane resulting in higher rate of free CRM and of complete TME specimen grade (Quirke Score) can be accomplished. However, taTME remains a hot topic in the current scientific literature. In Norway and the Netherlands a higher rate of anastomotic leakage as well as a higher rate of local recurrence (9.5%) with multifocal growth pattern were described.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
300
Department of surgery, Cantonal hospital of St. Gallen
Sankt Gallen, Canton of St. Gallen, Switzerland
RECRUITINGOverall survival
time from surgery to end of follow-up or death
Time frame: 60 months
cancer-specific survival
time from surgery to end of follow-up or death due to rectal cancer
Time frame: 60 months
disease-specific survival
time from surgery to end of follow-up or death due to or recurrence of rectal cancer
Time frame: 60 months
positive resection margin
tumor extending to the resection margin in pathological examination (R0, R1)
Time frame: 30 days
Quirke Score
Quality of mesorectal excision in pathological examination (Good, modest, bad)
Time frame: 30 days
circular resection margin (CRM)
size of circular resection margin (mm) in pathological examination
Time frame: 30 days
number of lymph nodes
number of lymph nodes in pathological examination
Time frame: 30 days
postoperative morbidity
Number of patients with postoperative complications (bleeding, anastomotic leakage, ileus, sacral infect, fistula, other surgical complications). The complications will be classified according the Clavien-Dindo-Classification
Time frame: 30 days
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postoperative 90-day mortality
Number of patients who die in the first 90 days after surgery
Time frame: 90 days
relapse-free survival
local recurrence
Time frame: 60 months
recurrence-free survival
local or systemic recurrence
Time frame: 60 months