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The role of transanal compared to laparoscopic total mesorectal excision (taTME vs. lapTME) for the treatment of mid-low rectal cancer in obese patients: outcomes of a multicenter propensity-matched analysis

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A Correction to this article was published on 22 November 2023

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Abstract

To compare the rate of sphincter-saving interventions between transanal and laparoscopic Total Mesorectal Excision in this particular group of patients. A multicentre observational study was conducted using a prospective database, including patients diagnosed with rectal cancer below the peritoneal reflection and BMI ≥ 30 kg/m2, who underwent minimally invasive elective surgery over a 5-year period. Exclusion criteria were (1) sphincter and/or puborectalis invasion; (2) multi-visceral resections; (3) palliative surgeries. The study population was divided into two groups according to the intervention: transanal or laparoscopic total mesorectal excision. The primary outcome was the rate of sphincter-saving surgery. Secondary outcomes included conversion, postoperative complications, quality of the specimen, and survival. A total of 93 patients were included; 40 (43%) transanal total mesorectal excision were compared to 53 (57%) laparoscopic. In addition, 35 cases of transanal approach were case-matched with an equal number of laparoscopic approaches, based on gender, tumor’s height, and neoadjuvant therapy. In both groups, 43% of the patients had low rectal cancer; however, the rate of sphincter-saving surgery was significantly higher in the transanal group (97% vs. 71%, p = 0.003). There were no conversions to open surgery in the transanal group, compared to 2 cases in the laparoscopic group (6%) (p = 0.246). The percentage of major complications was similar, including the rate of anastomotic leakage (10% transanal vs. 19% laparoscopic, p = 0.835). In our experience, higher percentages of sphincter-saving procedures and lower conversion rates are potential benefits of using the transanal approach in a complex surgical setting population of obese patients with mid-low rectal tumors when compared to laparoscopic.

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Data availability

The data that support the findings of this study are available from the corresponding author, [PT], upon reasonable request.

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Acknowledgements

The authors would like to thank Dr. Sara Rosenstone Calvo for editing this manuscript.

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Authors and Affiliations

  1. Colorectal Surgery Department, University Hospital Gregorio Marañon, Madrid, Spain

    Patricia Tejedor, Jaime Zorrilla & Luis Miguel Jiménez

  2. Colorectal Surgery Department, University Clinic of Navarre, Madrid & Pamplona, Spain

    Jorge Arredondo & Vicente Simó

  3. Colorectal Surgery Department, University Hospital Rio Hortega, Valladolid, Pamplona, Spain

    Jorge Arredondo, Jorge Baixauli & Carlos Pastor

  4. Colorectal Surgery Department, University Hospital of Leon, Leon, Spain

    Vicente Simó

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  1. Patricia Tejedor
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Contributions

PT and CP contributed equally to analyzing the data and writing the manuscript. The rest of the authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

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Correspondence to Carlos Pastor.

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All procedures performed in studies involving humans were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments.

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Tejedor, P., Arredondo, J., Simó, V. et al. The role of transanal compared to laparoscopic total mesorectal excision (taTME vs. lapTME) for the treatment of mid-low rectal cancer in obese patients: outcomes of a multicenter propensity-matched analysis. Updates Surg 75, 2191–2200 (2023). https://doi.org/10.1007/s13304-023-01676-4

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