Clinical colorectal cancer · 2025
Long-term Oncological Outcomes of Transanal Total Mesorectal Excision in Rectal Cancer: A Retrospective Study from a High-Volume Italian Center.
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Persiani Roberto, Tirelli Flavio, Lorenzon Laura, Neri Ilaria, Agnes Annamaria, Pascariello Massimo, Santoro Gloria, Biondi Alberto
Аннотация
BACKGROUND: Despite the documented technical advantages in terms of pelvis dissection and increased rate of sphincter-preserving procedures, the long-term oncological outcomes after transanal total mesorectal excision (TaTME) are still a matter of debate. This study aimed to report mid- and long-term survival outcomes of patients with rectal cancer treated with TaTME.
METHODS: Patients with non-metastatic mid to low rectal adenocarcinoma who underwent double-team trans-anal/laparoscopic trans-abdominal total mesorectal excision between 2015 and 2020 were selected and reviewed. Three and 5-year overall survival (OS), 3 and 5-year disease-free survival (DFS), 3 and 5-year disease-specific survival (DSS), and 3 and 5-year local recurrence (LR) rate. Univariable and multivariable analyses were performed to correlate clinical and pathological variables with the outcomes of interest.
RESULTS: Of 146 patients treated with TaTME during the study period, 114 non-metastatic patients were analyzed (M/F 1.7; mean age: 69.1 years). The mean follow-up time was 58.6 months. Sixty four percentage received neoadjuvant treatment before TaTME. Pathologic stages were documented as being stage 0-I in 62 (54.4%) and stage II-III in the remaining 52 patients (45.6%); 5 patients had a positive circumferential margin (4.4%), and overall, one-third of the cohort received adjuvant therapy. 3-year survival outcomes were: OS 89.4%, DFS 95.5%, DSS 85.5%, and LR 3.5%. The multivariable analysis of the 3-year outcomes showed a significant association between OS and age at the time of surgery and between DFS and pathological stages. A 5-year survival analysis was conducted on 68 patients. 5-year survivals were OS 75.0%, DFS 91.0%, and DSS 82.0%. Multivariate analysis showed that elderly age had a negative impact on 5-year OS.
CONCLUSIONS: When performed by experienced surgeons in a high-volume center, TaTME is a mini-invasive procedure with good mid/long-term oncological outcomes.
METHODS: Patients with non-metastatic mid to low rectal adenocarcinoma who underwent double-team trans-anal/laparoscopic trans-abdominal total mesorectal excision between 2015 and 2020 were selected and reviewed. Three and 5-year overall survival (OS), 3 and 5-year disease-free survival (DFS), 3 and 5-year disease-specific survival (DSS), and 3 and 5-year local recurrence (LR) rate. Univariable and multivariable analyses were performed to correlate clinical and pathological variables with the outcomes of interest.
RESULTS: Of 146 patients treated with TaTME during the study period, 114 non-metastatic patients were analyzed (M/F 1.7; mean age: 69.1 years). The mean follow-up time was 58.6 months. Sixty four percentage received neoadjuvant treatment before TaTME. Pathologic stages were documented as being stage 0-I in 62 (54.4%) and stage II-III in the remaining 52 patients (45.6%); 5 patients had a positive circumferential margin (4.4%), and overall, one-third of the cohort received adjuvant therapy. 3-year survival outcomes were: OS 89.4%, DFS 95.5%, DSS 85.5%, and LR 3.5%. The multivariable analysis of the 3-year outcomes showed a significant association between OS and age at the time of surgery and between DFS and pathological stages. A 5-year survival analysis was conducted on 68 patients. 5-year survivals were OS 75.0%, DFS 91.0%, and DSS 82.0%. Multivariate analysis showed that elderly age had a negative impact on 5-year OS.
CONCLUSIONS: When performed by experienced surgeons in a high-volume center, TaTME is a mini-invasive procedure with good mid/long-term oncological outcomes.
Предметные рубрики MeSH
HumansRectal NeoplasmsMaleFemaleAgedRetrospective StudiesAdenocarcinomaMiddle AgedItalyNeoplasm Recurrence, LocalProctectomyDisease-Free SurvivalTransanal Endoscopic SurgeryFollow-Up StudiesAged, 80 and overHospitals, High-VolumeTreatment OutcomeNeoadjuvant TherapySurvival RateLaparoscopyNeoplasm Staging