Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
Zuyderland Medical Centre, Sittard-Geleen and Heerlen, Dordrecht, the Netherlands.
Br J Surg. 2020 Aug;107(9):1211-1220. doi: 10.1002/bjs.11525. Epub 2020 Apr 4.
Transanal total mesorectal excision (TaTME) has been proposed as an approach in patients with mid and low rectal cancer. The TaTME procedure has been introduced in the Netherlands in a structured training pathway, including proctoring. This study evaluated the local recurrence rate during the implementation phase of TaTME.
Oncological outcomes of the first ten TaTME procedures in each of 12 participating centres were collected as part of an external audit of procedure implementation. Data collected from a cohort of patients treated over a prolonged period in four centres were also collected to analyse learning curve effects. The primary outcome was the presence of locoregional recurrence.
The implementation cohort of 120 patients had a median follow up of 21·9 months. Short-term outcomes included a positive circumferential resection margin rate of 5·0 per cent and anastomotic leakage rate of 17 per cent. The overall local recurrence rate in the implementation cohort was 10·0 per cent (12 of 120), with a mean(s.d.) interval to recurrence of 15·2(7·0) months. Multifocal local recurrence was present in eight of 12 patients. In the prolonged cohort (266 patients), the overall recurrence rate was 5·6 per cent (4·0 per cent after excluding the first 10 procedures at each centre).
TaTME was associated with a multifocal local recurrence rate that may be related to suboptimal execution rather than the technique itself. Prolonged proctoring, optimization of the technique to avoid spillage, and quality control is recommended.
经肛门全直肠系膜切除术（TaTME）已被提议用于中低位直肠癌患者。TaTME 手术已在荷兰通过包括指导在内的结构化培训途径引入。本研究评估了 TaTME 实施阶段的局部复发率。
作为对手术实施情况外部审核的一部分，收集了 12 个参与中心中每个中心前 10 例 TaTME 手术的肿瘤学结果。还收集了四个中心中经过长时间治疗的患者队列的数据，以分析学习曲线效应。主要结局是局部区域复发的存在。
120 例实施队列的中位随访时间为 21.9 个月。短期结果包括阳性环周切缘率为 5.0%，吻合口漏率为 17.0%。实施队列的总体局部复发率为 10.0%（120 例中有 12 例），复发的平均（标准差）间隔为 15.2（7.0）个月。12 例患者中有 8 例存在多灶性局部复发。在长期队列（266 例患者）中，总体复发率为 5.6%（排除每个中心的前 10 例后为 4.0%）。
TaTME 与多灶性局部复发率相关，这可能与执行不当而非技术本身有关。建议延长指导、优化避免溢出的技术以及进行质量控制。
