Benefit of laparoscopic two-team transanal beyond total mesorectal excision for advanced and recurrent rectal cancer with invasion: a retrospective study compared with conventional laparoscopic approach.

BACKGROUND: The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.

METHODS: This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).

RESULTS: In total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.

CONCLUSIONS: Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.