Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer : a multicenter comparative analysis
De Lacy, F.B (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Roodbeen, S. X. (Cancer Center Amsterdam. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam)
Ríos, J. (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
van Laarhoven, J. (Jeroen Bosch Ziekenhuis. Department of General Surgery)
Otero-Piñeiro, A. (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Bravo, R. (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Visser, T. (Gelderse Vallei Hospital. Department of Surgery)
van Poppel, R. (Gelderse Vallei Hospital. Department of Surgery)
Valverde, S. (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Hompes, Roel (Cancer Center Amsterdam. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam)
Sietses, C. (Gelderse Vallei Hospital. Department of Surgery)
Castells, Antoni (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Bemelman, W. A. (Cancer Center Amsterdam. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam)
Tanis, P. J. (Cancer Center Amsterdam. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam)
Lacy Fortuny, Antonio Ma. de (Institut d'Investigacions Biomèdiques August Pi i Sunyer)

Date:	2020
Abstract:	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). 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. 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). These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.
Note:	Altres ajuts: This work has been funded by the Resident Award "Emili Letang," granted by Hospital Clinic of Barcelona, Research, Innovation, and Education Departments (Grant number: 25_delacyoliverb_250709_cgicm_pfr2018). The funder of this study supported the data collection and database management.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Rectal cancer ; Total mesorectal excision ; Locoregional recurrence ; TaTME
Published in:	BMC Cancer, Vol. 20 (july 2020) , ISSN 1471-2407

DOI: 10.1186/s12885-020-07171-y
PMID: 32689968

12 p, 1.2 MB

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