Transanal versus conventional total mesorectal excision for rectal cancer using the IDEAL framework for implementation
| Autor: | Terry Phang, Manoj J. Raval, R L Robertson, Ahmer A. Karimuddin, Carl J. Brown |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty AcademicSubjects/MED00910 Colorectal cancer Anastomotic Leak 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Laparoscopy Propensity Score Survival rate Digestive System Surgical Procedures Aged Retrospective Studies Transanal Endoscopic Surgery Retrospective review medicine.diagnostic_test business.industry Rectal Neoplasms Rectum General Medicine Middle Aged medicine.disease Total mesorectal excision Surgery Dissection Treatment Outcome 030220 oncology & carcinogenesis Cohort Propensity score matching 030211 gastroenterology & hepatology Original Article Female Neoplasm Recurrence Local business AcademicSubjects/MED00010 |
| Zdroj: | BJS Open |
| ISSN: | 2474-9842 |
| Popis: | Background Transanal total mesorectal excision (TaTME) is an innovative technique for distal rectal cancer dissection. It has been shown to have similar short-term outcomes to conventional open and laparoscopic total mesorectal excision (cTME), but recent studies have raised concern about increased morbidity and local recurrence rates. The aim of this study was to assess outcomes after TaTME versus cTME for rectal cancer. Methods TaTME was implemented in 2014 using IDEAL principles in a single institution. The institution maintains databases for all patients undergoing rectal cancer surgery. This retrospective review compared data collected from all patients who had TaTME with those from a propensity-matched cohort of patients who underwent cTME. The primary outcome was a composite pathological measure combining margin status and quality of total mesorectal excision (TME). Short-term clinical and survival outcomes were also measured. Results Propensity matching created 109 matched pairs for analysis. Nine patients (8.3 per cent) undergoing TaTME had positive margins and/or incomplete TME, compared with 11 (10.5 per cent) undergoing cTME (P = 0.65). There were no significant differences in morbidity between the TaTME and cTME groups, including number of anastomotic leaks (13.8 versus 18.3 per cent; P = 0.37). The estimated 3-year local recurrence-free survival rate was 96.3 per cent in both groups (P = 0.39). Estimated 3-year overall (93.6 per cent for TaTME versus 94.5 per cent for cTME; P = 0.09) and disease-free (88.1 versus 76.1 per cent; P = 0.90) survival rates were similar. Conclusion TaTME provided similar outcomes to cTME for rectal cancer with the application of IDEAL principles. This study assessed the outcomes of a single-institution prospectively collected cohort of patients undergoing transanal total mesorectal excision (TaTME) for rectal cancer, compared with a propensity-matched cohort of patients undergoing conventional surgery. Methods from the IDEAL framework were used to institute TaTME. There were no significant differences in histopathological, clinical or survival outcomes between the two groups. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|