1. Transanal total mesorectal excision: international registry results of the first 720 cases
- Author
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Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, Albert M, Al Furajii H, Allison A, Arezzo A, Aryal K, Ashraf S, Atallah S, Baig K, Baral J, Bemelman W, Berger D, Boni L, Bonjer J, Bordeianou L, Borreca D, Buchs NC, Cahill R, Campbell K, Capolupo G, Caricato M, Cassinotti E, Chambers W, Courtney ED, Cunningham C, Dalton S, Dawson R, Delrio P, de Graaf E, De Paolis P, D'Hondt M, D'Hoore A, Doornebosch P, Erikson JR, Estevez-Schwarz L, Fabryko M, Fernandez-Hevia M, Forsmo H, Francis N, Garimella V, Gecim IE, Geissmann D, Gill K, Glockler M, Grieco M, Grolich T, Guy R, Hayes J, Hoffman TJ, Houben B, Ito M, Jelic F, Jones O, Joy H, Kala Z, Katory M, Kneist W, Knol J, Korsgen S, Kukreja N, Kunz R, Lacy A, Lal R, Lang H, La Vaccara V, Lezoche E, Lima MA, Mamedli Z, Mansfield S, Marsanic P, Mellano A, Mendes CRS, Merrie A, Miles A, Miroshnychenko Y, Morino M, Muratore A, Nicol D, Oh JH, O'Loughlin P, Pandey S, Paraoan M, Pei CFW, Perez RO, Pfeffer F, Picchetto A, Pockney P, Radley S, Rasulov A, Rega D, Ris F, Riss S, Sains P, Samarasinghe S, Juliao GPS, Seitinger G, Shaikh I, Sietses C, Sileri P, Fernandez VS, Smith S, Sohn DK, Speakman C, Stevenson A, Stift A, Sylla P, Tanis P, Teso EP, Tuech JJ, Tuynman J, van der Zaag E, van Duijvendijk P, Van Nieuwenhove Y, Vansteenkiste F, Velthuis S, Venkatsubramaniam A, Vorburger S, Wassenaar E, Wegstapel H, Wolthuis A, Wu L, Penna, M, Hompes, R, Arnold, S, Wynn, G, Austin, R, Warusavitarne, J, Moran, B, Hanna, Gb, Mortensen, Nj, Tekkis, Pp, Albert, M, Al Furajii, H, Allison, A, Arezzo, A, Aryal, K, Ashraf, S, Atallah, S, Baig, K, Baral, J, Bemelman, W, Berger, D, Boni, L, Bonjer, J, Bordeianou, L, Borreca, D, Buchs, Nc, Cahill, R, Campbell, K, Capolupo, G, Caricato, M, Cassinotti, E, Chambers, W, Courtney, Ed, Cunningham, C, Dalton, S, Dawson, R, Delrio, P, de Graaf, E, De Paolis, P, D'Hondt, M, D'Hoore, A, Doornebosch, P, Erikson, Jr, Estevez-Schwarz, L, Fabryko, M, Fernandez-Hevia, M, Forsmo, H, Francis, N, Garimella, V, Gecim, Ie, Geissmann, D, Gill, K, Glockler, M, Grieco, M, Grolich, T, Guy, R, Hayes, J, Hoffman, Tj, Houben, B, Ito, M, Jelic, F, Jones, O, Joy, H, Kala, Z, Katory, M, Kneist, W, Knol, J, Korsgen, S, Kukreja, N, Kunz, R, Lacy, A, Lal, R, Lang, H, La Vaccara, V, Lezoche, E, Lima, Ma, Mamedli, Z, Mansfield, S, Marsanic, P, Mellano, A, Mendes, Cr, Merrie, A, Miles, A, Miroshnychenko, Y, Morino, M, Muratore, A, Nicol, D, Oh, Jh, O'Loughlin, P, Pandey, S, Paraoan, M, Pei, Cfw, Perez, Ro, Pfeffer, F, Picchetto, A, Pockney, P, Radley, S, Rasulov, A, Rega, D, Ris, F, Riss, S, Sains, P, Samarasinghe, S, Juliao, Gp, Seitinger, G, Shaikh, I, Sietses, C, Sileri, P, Fernandez, V, Smith, S, Sohn, Dk, Speakman, C, Stevenson, A, Stift, A, Sylla, P, Tanis, P, Teso, Ep, Tuech, Jj, Tuynman, J, van der Zaag, E, van Duijvendijk, P, Van Nieuwenhove, Y, Vansteenkiste, F, Velthuis, S, Venkatsubramaniam, A, Vorburger, S, Wassenaar, E, Wegstapel, H, Wolthuis, A, Wu, L, Surgery, CCA - Cancer Treatment and quality of life, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and AGEM - Digestive immunity
- Subjects
Male ,SURGERY ,medicine.medical_treatment ,Anal Canal ,registry ,Body Mass Index ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,PATHOLOGICAL OUTCOMES ,Registries ,Intraoperative Complications ,Neoadjuvant therapy ,Digestive System Surgical Procedures ,11 Medical and Health Sciences ,Aged, 80 and over ,education.field_of_study ,Anal canal ,Middle Aged ,Total mesorectal excision ,Neoadjuvant Therapy ,RANDOMIZED CLINICAL-TRIAL ,Dissection ,medicine.anatomical_structure ,Treatment Outcome ,transanal total mesorectal excision ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Life Sciences & Biomedicine ,Adult ,medicine.medical_specialty ,Adolescent ,Population ,Perforation (oil well) ,LOW-RECTAL-CANCER ,Rectum ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,education ,rectal cancer ,MARGIN INVOLVEMENT ,Mesorectal ,Aged ,Neoplasm Staging ,Science & Technology ,poor histological outcomes ,LAPAROSCOPIC-ASSISTED RESECTION ,business.industry ,Rectal Neoplasms ,TaTME Registry Collaborative ,Surgery ,Surgery, poor histological outcomes, rectal cancer, registry, risk factors, transanal total mesorectal excision ,business - Abstract
OBJECTIVE: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology. BACKGROUND: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population. METHODS: Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome. RESULTS: A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor CONCLUSIONS: TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.
- Published
- 2017