43 - Freie Mitteilung
16. Mai 2019, 08:30 - 10:00, Szenario 1, 5. OG
Outcomes of 97 consecutive transanal total mesorectal excisions for low rectal cancer
S. Gloor1, 2, R. Troller1, 3, F. Glieder1, H. Gelpke1, S. Breitenstein1, M. Adamina1, Presenter: S. Gloor1, 2 (1Winterthur, 2Wetzikon, 3London/UK)
Transanal total mesorectal excision (taTME) is an alternative to conventional total mesorectal excision owing to its reported superior ability to achieve clear distal and circumferential resection margins in low rectal cancers.
Consecutive patients with low rectal cancer treated at a single centre by taTME were included in a prospective cohort study. Patients who qualified for a partial mesorectal excision (PME) were excluded and treated by conventional laparoscopic PME. Perioperative and short-term oncologic outcomes were measured along regular clinic visits and the results were reported as median and interquartile range (IQR).
97 patients with a low rectal cancer (6.5 cm to anal verge, IQR 5-9) underwent a taTME between Feb 2013 and December 2018. Age and body mass index were 65.5 years (IQR 57-76) and 26 kg/m2 (IQR 22.8-29.). There were 71 males and 26 females. 64 (62%) patients had neoadjuvant radiochemotherapy. Surgery time was 350 minutes (IQR 306-422), including an ileostomy in all patients. Performing taTME in a 2-team technique saved 79.5 minutes or 19.6% operating time (p=0.009, t-test one-team (n=39, 406 minutes, IQR 344-465) vs. 2-team (n=58, 326.5 minutes, IQR 287-369). Dissection of the mesorectum was excellent (91.8% Quirke 3) and all distal and circumferential margins were clear. Median T stage was 3 (IQR 2-3). 35 patients had lymphnode metastases for a median number of retrieved nodes of 26 (IQR 20-38). Cumulative 30-day morbidity amounted to 18.6% minor complications (Dindo Clavien II) and 26.8% major complications (Dindo Clavien III-V), including 10 anastomotic leaks (10.3%) and 3 reoperations (3.1%). Most of the leaks could be managed endoscopically and the ileostomy reversed at last. Median length of hospital stay was 10 days (IQR 8-14).
Transanal total mesorectal excision allows good surgical and oncologic quality to the expenses of a reasonable surgery time and morbidity.