Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis.

Autor: de Lacy FB; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain. borjalacy@gmail.com., Roodbeen SX; Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Ríos J; Medical Statistics Core Facility, August Pi and Sunyer Biomedical Research Institute (IDIBAPS); Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain., van Laarhoven J; Department of General Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands., Otero-Piñeiro A; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain., Bravo R; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain., Visser T; Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands., van Poppel R; Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands., Valverde S; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain., Hompes R; Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Sietses C; Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands., Castells A; Department of Gastroenterology, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain., Bemelman WA; Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Tanis PJ; Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Lacy AM; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain.
Jazyk: angličtina
Zdroj: BMC cancer [BMC Cancer] 2020 Jul 20; Vol. 20 (1), pp. 677. Date of Electronic Publication: 2020 Jul 20.
DOI: 10.1186/s12885-020-07171-y
Abstrakt: Background: For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME).
Methods: Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence.
Results: A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1-6.1) in the TaTME group and 9.6% (95% CI, 6.5-12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23-0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8-79.8) and 68.6% (95% CI, 63.7-73.5) (HR = 0.82; 95% CI, 0.65-1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7-91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53-1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62-0.98; p = 0.033).
Conclusions: These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.
Databáze: MEDLINE
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