Jonathan Josse, MD, Brigitte Anderson, BS, Henry Schoonyoung, MD, John Marks, MD. Lankenau Medical Center
Introduction: TaTME has emerged as a new popular approach for rectal cancer surgery. An incision through the anus or rectum provides a natural orifice route to deliver the specimen and avoid an abdominal extraction site. Concerns regarding the applicability of this approach in patients with large tumors, or high BMI and possible oncologic risks of this approach have often limited the adoption of Transanal extraction (TAE). We examine our experience with the routine use of TAE for TaTME and TATA over a 10 year period, to identify its impact on TME grade, local recurrence (LR) and morbidity.
Methods: From a prospectively maintained laparoscopic and rectal cancer database, all patients with primary adenocarcinoma of the rectum, treated with neoadjuvant therapy and a TaTME/TATA between 2008-2018 were identified. Retrospective review of the operative notes determined the route of specimen extraction in these patients as either abdominal (abd) or Transanal (TAE). The TAE group was analyzed to determine overall TME completeness, LR and morbidity. Subclass analysis of these outcomes was carried out based on BMI ≥ 30, size, ≥5cm, and circumferential versus non–circumferential cancers.
Results: Of the 128 eligible patients, 99.2% of specimens were extracted transanally, and comprise these results (N=127). The mean age of our patients was 59 years old, with 28% being female. TME grade on final pathology was incomplete-2%, near complete-3%, and Complete-95%. Local recurrence was 1.6%. There was one case of carcinomatosis. Overall 60-day morbidity was 32.3% with 63.4% having a Clavien-Dindo score of ≤ 2. There was no mortality. The effect of BMI and size of the cancer, on TME, LR and morbidity are shown in Table 1.
Conclusion: This study establishes that the Transanal extraction of the specimen can be routinely used for TaTME, without impairing the quality of the TME, increasing LR rates, carcinomtosis or morbidity. Transanal extraction is shown as safe for morbidly obese patients with large cancers as well. The primary concerns of Transanal extraction of the rectal cancer specimen regarding the compromise of the TME specimens and/or increased morbidity appears unfounded.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95686
Program Number: P288
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster