Mid-term oncological outcomes of transanal total mesorectal excision for rectal cancer: a prospective, single center, randomized controlled trial
[Objectives] To compare mid-term oncological outcomes between transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (lapTME) for rectal cancer. [Methods] This was a prospective randomized controlled trial of 68 patients with mid-and low rectal cancer admitted to the...
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| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Journal of Colorectal & Anal Surgery
2022-12-01
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| Series: | 结直肠肛门外科 |
| Subjects: | |
| Online Access: | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=322&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC6%E6%9C%9F |
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| Summary: | [Objectives] To compare mid-term oncological outcomes between transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (lapTME) for rectal cancer. [Methods] This was a prospective randomized controlled trial of 68 patients with mid-and low rectal cancer admitted to the Nanchong Central Hospital—Affiliated Hospital of North Sichuan Medical College for planned radical surgery between December 2018 and April 2021. Patients were randomly assigned to the taTME group (n=33) and the lapTME group (n=35) using a random number table. One patient in the lapTME group was found during exploration to have peritoneal metastasis and excluded. The final study included 33 patients in the taTME group and 34 patients in the lapTME group. Pathology and follow-up data were collected and analyzed. Primary endpoints included two-year overall survival (OS), two-year disease-free survival (DFS), local recurrence, distant metastasis, and death. Secondary endpoint was pathology findings. [Results] No patients in either group showed positive distal resection margin or positive circumferential resection margin. The two groups did not differ significantly in terms of length of specimen, tumor length, distance between proximal and distal resection margin, distance between circumferential resection margin, grade of mesangial integrity, lymph node yield, T stage, N stage, and TNM stage (P>0.05). No patients were lost to follow-up. The Median follow-up was 31 (12, 40) months. Up to April 2022, no patients had local recurrence. One patient in the taTME group (3.0%) and one in the lapTME group (2.9%) was found to have lung metastasis at 18 and 19 months after surgery, respectively. No liver or other distant metastasis was reported. One patient in the taTME group died due to multiorgan failure caused by postoperative lung infection; one patient in the lapTME group had sudden death due to cardiac arrest at 1 month after surgery; no further death was reported during the follow-up period. The overall mortality rate was 3.0% in the taTME group and 2.9% in the lapTME group (P=1.000). Two-year OS was 97.0% in the taTME group and 97.1% in the lapTME group (P=0.986). Two-year DFS was 93.9% in the taTME group and 94.1% in the lapTME group (P=0.974). [Conclusion] TaTME is a safe and feasible treatment option for mid-and low rectal cancer. It can achieve comparable effectiveness and satisfactory mid-term oncological outcomes as lapTME. |
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| ISSN: | 1674-0491 |