Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis.

BACKGROUND

Transanal total mesorectal excision is a novel and promising technique in the treatment of low and middle rectal cancer.

OBJECTIVE

This study aimed to compare the safety and feasibility of transanal total mesorectal excision versus laparoscopic total mesorectal excision.

DESIGN

This was a retrospective study using propensity score matching analysis.

SETTINGS

This study was conducted in a single high-volume university hospital.

PATIENTS

Patients with low and middle rectal cancer who underwent total mesorectal excision with curative intent between 2007 and 2017 were recruited.

INTERVENTIONS

Laparoscopic total mesorectal excision and transanal total mesorectal excision had been performed.

MAIN OUTCOME MEASURES

Intraoperative, pathological, and 30-day postoperative outcomes were compared between the transanal and laparoscopic groups.

RESULTS

Overall, 105 patients were selected from the whole sample of 316 patients with rectal cancer. After propensity score matching analysis, 46 patients for each group were compared. Laparoscopic total mesorectal excision was associated with a higher conversion rate to open surgery (19.6% vs 0%, p = 0.002). Transanal total mesorectal excision showed a longer distal resection margin (15 mm vs 25 mm; p < 0.001), and similar results regarding the completeness of mesorectal excision and circumferential resection margin involvement, compared to laparoscopy. There were no statistically significant differences between the 2 groups in terms of postoperative complications.

LIMITATIONS

The study was limited by its retrospective design and the small size of the sample.

CONCLUSIONS

Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes.