Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands

BACKGROUND:Transanal total mesorectal excision (TaTME) is a relatively new and demanding technique forrectal cancer treatment. Results from national datasets are absent and comparative data withlaparoscopic TME (lapTME) are scarce. Therefore, this study aimed to evaluate the initialTaTME experience in the Netherlands, by comparing outcomes with conventional lapTME.
STUDY DESIGN:Patients with rectal cancer who underwent curative TaTME or lapTME were selected fromthe nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 andDecember 2017. Primary outcome was circumferential resection margin (CRM) involve-ment. Secondary outcomes included operative details and short-term (<30 days) clinicalcourse. Propensity score matching was performed for 7 factors.
RESULTS:There were 3,777 patients included for analysis (TaTME, n¼416, lapTME, n¼3361).Transanal TME was performed in 38 hospitals and lapTME in 90 hospitals. Before match-ing, the patient category within the TaTME group was technically more challenging in termsof tumor height and preoperative threatened margins. After 1:1 matching, 396 patients wereincluded in each group, with comparable baseline characteristics. Circumferential resectionmargin involvement was 4.3% after TaTME and 4.0% after lapTME (p¼1.000). Conver-sion rate was significantly lower in TaTME (1.5% vs 8.6%, p<0.001). Anastomotic leakrate was not significantly different (16.5% vs 12.2%, p¼0.116). Other postoperative out-comes were also comparable between the groups. Significant independent risk factors forCRM involvement in TaTME were preoperative threatened margin on MRI (odds ratio[OR] 5.48, 95% CI 1.33 to 22.54) and conversion (OR 30.12, 95% CI 3.70 to 245.20).
CONCLUSIONS:This first nationwide study shows early experience with adoption of TaTME in theNetherlands. Considering that current data represent initial TaTME experience, acceptableshort-term outcomes were demonstrated when compared with the well-establishedlapTME.