Transanal total mesorectal excision for abdominoperineal resection is associated with poor oncological outcomes in rectal cancer patients: A word of caution from a multicentric Canadian cohort study Academic Article uri icon

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abstract

  • Aim

    The main objective of this study was to compare the oncological outcomes of patients undergoing abdominoperineal resection (APR) versus low anterior resection (LAR) through a transanal total mesorectal excision (taTME) approach.

    Method

    A total of 360 adult patients with a diagnosis of rectal cancer were enrolled at participating centres from the Canadian taTME Expert Collaboration. Forty-three patients received taTME-APR and received 317 taTME-LAR. Demographic, operative, pathological and follow-up data were collected and merged into a single database. Results are presented as hazard ratio (HR) and 95% confidence interval. All analyses were performed in the R environment (v.3.6).

    Results

    The proportion of patients with a positive circumferential radial margin status was higher in the taTME-APR group than the taTME-LAR group (21% vs. 9%, p = 0.001). Complete TME was achieved in 91% of those undergoing APR compared with 96% of those undergoing LAR (p = 0.25). APR was associated with a greater rate of local recurrence relative to LAR, although it was not significant [crude HR = 3.53 (95% CI 0.92-13.53)]. Circumferential margin positivity was significantly associated with a higher rate of systemic recurrence [crude HR = 3.59 (95% CI 1.38-9.3)].

    Conclusion

    Our results demonstrate inferior outcomes in those undergoing taTME-APR compared with taTME-LAR. The use of this technique for this particular indication needs to be carefully considered.

authors

  • Caycedo‐Marulanda, Antonio
  • Verschoor, Chris P
  • Brown, Carl P
  • Karimuddin, Ahmer
  • Raval, Manoj
  • Phang, Terry
  • Vikis, Elena
  • Melich, George
  • Patel, Sunil V
  • AlGhurair, Abdulaziz
  • Ashamalla, Shady
  • Bogach, Jessica
  • Bouchard, Alexandre
  • Bouchard, Phillipe
  • Chadi, Sami
  • Dagbert, Francois
  • Drolet, Sebastien
  • Kazazian, Karineh
  • Lee, Lawrence
  • Letarte, Francois
  • Sender Lieberman, A
  • Quereshy, Fayez
  • Hameed, Usman
  • Stotland, Peter
  • Zhang, David DQ

publication date

  • April 2022