Completion total mesorectal excision following transanal endoscopic microsurgery does not compromise outcomes in patients with rectal cancer

Surgical Endoscopy And Other Interventional Techniques - Tập 36 - Trang 1181-1190 - 2021
Katarina Levic Souzani1, Orhan Bulut1,2, Tine Plato Kuhlmann3,2,4, Ismail Gögenur5,2,4, Thue Bisgaard5,4
1Gastrounit - Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
2Institution of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
3Department of Pathology, Herlev University Hospital, Copenhagen, Denmark
4Danish Colorectal Cancer Group, Copenhagen, Denmark
5Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark

Tóm tắt

Transanal endoscopic microsurgery (TEM) represents a choice of treatment in patients with neoplastic lesions in the rectum. When TEM fails, completion total mesorectal excision (cTME) is often required. However, a concern is whether cTME increases the rate of abdominoperineal resections (APR) and is associated with higher risk of incomplete mesorectal fascia (MRF) resection. The aim of this study was to compare outcomes of cTME with primary TME (pTME) in patients with rectal cancer. This was a nationwide study on all patients with cTME from the Danish Colorectal Cancer Group database between 2005 and 2015. Patients with cTME were compared to patients with pTME after propensity score matching (matching ratio 1:2). Matching variables were age, gender, tumor distance from anal verge, American Society of Anesthesiologists (ASA) score and American Joint Committee on Cancer (AJCC) stage. A total of 60 patients with cTME were compared with 120 patients with pTME. Patients with cTME experienced more intraoperative complications as compared to pTME patients (18.3% vs. 6.7%, p = 0.021). However, there was no difference in the rate of perforations at or near the tumor/previous TEM site (6.7% vs. 2.5%, p = 0.224), conversion to open surgery (p = 0.733) or 30-day morbidity (p = 0.86). On multivariate analysis, cTME was not a risk factor for APR (OR 2.49; 95% CI 0.95–6.56; p = 0.064) or incomplete MRF (OR 1.32; 95% CI 0.48–3.63; p = 0.596). There was no difference in the rate of local recurrence between cTME and pTME (5.2% vs. 4.3%, p = 0.1), distant metastases (6.8% vs. 6.8%, p = 1), or survival (p = 0.081). The mean follow-up time was 6 years. In our study, the largest so far on the subject, we find no difference in postoperative short- or long-term outcomes between cTME and pTME.

Tài liệu tham khảo

Puli SR, Bechtold ML, Reddy JBK, Choudhary A, Antillon MR, Brugge WR (2009) How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Meta-analysis and systematic review. Ann Surg Oncol 16:254–265. https://doi.org/10.1245/s10434-008-0231-5 Baatrup G, Elbrønd H, Hesselfeldt P, Wille-Jørgensen P, Møller P, Breum B, Qvist N (2007) Rectal adenocarcinoma and transanal endoscopic microsurgery. Diagnostic challenges, indications and short term results in 142 consecutive patients. Int J Colorectal Dis 22:1347–1352. https://doi.org/10.1007/s00384-007-0358-z O’Connell E, Galvin R, McNamara DA, Burke JP (2020) The utility of preoperative radiological evaluation of early rectal neoplasia: a systematic review and meta-analysis. Color Dis 22:1076–1084. https://doi.org/10.1111/codi.15015 Oien K, Mjørud Forsmo H, Rösler C, Nylund K, Waage JE, Pfeffer F (2019) Endorectal ultrasound and magnetic resonance imaging for staging of early rectal cancers: how well does it work in practice? Acta Oncol (Madr) 58:S49–S54. https://doi.org/10.1080/0284186X.2019.1569259 Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783. https://doi.org/10.1148/radiol.2323031368 Dell’Abate P, Iosca A, Galimberti A, Piccolo P, Soliani P, Foggi E (2001) Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: techniques and outcome. Dis Colon Rectum 44:112–118. https://doi.org/10.1007/bf02234832 Serra-Aracil X, Caro-Tarrago A, Mora-López L, Casalots A, Rebasa P, Navarro-Soto S (2014) Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum 57:823–829. https://doi.org/10.1097/DCR.0000000000000139 Levic K, Bulut O, Hesselfeldt P (2014) Transanal endoscopic microsurgery for giant polyps of the rectum. Tech Coloproctol 18:521–527. https://doi.org/10.1007/s10151-013-1069-9 Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ, Navarro-Soto S (2014) Transanal endoscopic surgery in rectal cancer. World J Gastroenterol 20:11538–11545. https://doi.org/10.3748/wjg.v20.i33.11538 De Graaf EJR, Doornebosch PG, Tollenaar RAEM, Meershoek-Klein Kranenbarg E, de Boer AC, Bekkering FC, van de Velde CJH (2009) Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol 35:1280–1285. https://doi.org/10.1016/j.ejso.2009.05.001 Lee W, Lee D, Choi S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17:1283–1287. https://doi.org/10.1007/s00464-002-8814-x Heintz A, Mörschel M, Junginger T (1998) Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 12:1145–1148 Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC (2015) Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum 58:122–140. https://doi.org/10.1097/DCR.0000000000000293 Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98:1635–1643. https://doi.org/10.1002/bjs.7584 Doornebosch PG, Tollenaar RAEM, Gosselink MP, Stassen LP, Dijkhuis CM, Schouten WR, Van De Velde CJ, De Graaf EJR (2007) Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Color Dis 9:553–558. https://doi.org/10.1111/j.1463-1318.2006.01186.x Logan RFA, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C, Committee EBCSE (2012) Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 61:1439–1446. https://doi.org/10.1136/gutjnl-2011-300843 Reggiani-Bonetti L, Di Gregorio C, Pedroni M, Domati F, Barresi V, Marcheselli L, Ponz De Leon M (2013) Incidence trend of malignant polyps through the data of a specialized colorectal cancer registry: clinical features and effect of screening. Scand J Gastroenterol 48:1294–1301. https://doi.org/10.3109/00365521.2013.838301 Chantereau MJ, Faivre J, Boutron MC, Piard F, Arveux P, Bedenne L, Hillon P (1992) Epidemiology, management, and prognosis of malignant large bowel polyps within a defined population. Gut 33:259–263. https://doi.org/10.1136/gut.33.2.259 Coton C, Lefevre JH, Debove C, Creavin B, Chafai N, Tiret E, Parc Y (2019) Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer? Color Dis 21:15–22. https://doi.org/10.1111/codi.14445 Eid Y, Alves A, Lubrano J, Menahem B (2018) Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature. J Visc Surg 155:445–452. https://doi.org/10.1016/j.jviscsurg.2018.03.008 Piessen G, Cabral C, Benoist S, Penna C, Nordlinger B (2012) Previous transanal full-thickness excision increases the morbidity of radical resection for rectal cancer. Colorectal Dis 14:445–452. https://doi.org/10.1111/j.1463-1318.2011.02671.x Morino M, Allaix ME, Arolfo S, Arezzo A (2013) Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Surg Endosc 27:3315–3321. https://doi.org/10.1007/s00464-013-2911-x Levic K, Bulut O, Hesselfeldt P, Bülow S (2013) The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study. Tech Coloproctol 17:397–403. https://doi.org/10.1007/s10151-012-0950-2 Bülow S, Christensen IJ, Iversen LH, Harling H (2011) Intra-operative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Color Dis 13:1256–1264. https://doi.org/10.1111/j.1463-1318.2010.02459.x Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN (2004) Inadvertent perforation during rectal cancer resection in Norway. Br J Surg 91:210–216. https://doi.org/10.1002/bjs.4390 Hompes R, McDonald R, Buskens C, Lindsey I, Armitage N, Hill J, Scott A, Mortensen NJ, Cunningham C, Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery Collaboration (2013) Completion surgery following transanal endoscopic microsurgery: assessment of quality and short- and long-term outcome. Colorectal Dis 15:e576–e581. https://doi.org/10.1111/codi.12381 Ingeholm P, Gögenur I, Iversen LH (2016) Danish colorectal cancer group database. Clin Epidemiol 8:465–468 Kronborg O, Danish Colorectal Cancer Group (DCCG) National Guidelines. In: Dan.Med.Bull. http://www.dccg.dk/03_Publikation/01_ret.html. Accessed 5 Dec 2017 Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213 Nagtegaal ID, Van de Velde CJH, Van Der Worp E, Kapiteijn E, Quirke P, Van Krieken JHJM (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734. https://doi.org/10.1200/JCO.2002.07.010 Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786 Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10:150–161. https://doi.org/10.1002/pst.433 Williams JG, Pullan RD, Hill J, Horgan PG, Salmo E, Buchanan GN, Rasheed S, McGee SG, Haboubi N, Association of Coloproctology of Great Britain and Ireland (2013) Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis 15(Suppl 2):1–38. https://doi.org/10.1111/codi.12262 van de Velde CJH, Boelens PG, Borras JM, Coebergh J-W, Cervantes A, Blomqvist L, Beets-Tan RGH, van den Broek CBM, Brown G, Van Cutsem E, Espin E, Haustermans K, Glimelius B, Iversen LH, van Krieken JH, Marijnen CAM, Henning G, Gore-Booth J, Meldolesi E, Mroczkowski P, Nagtegaal I, Naredi P, Ortiz H, Påhlman L, Quirke P, Rödel C, Roth A, Rutten H, Schmoll HJ, Smith JJ, Tanis PJ, Taylor C, Wibe A, Wiggers T, Gambacorta MA, Aristei C, Valentini V (2014) EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 50:1.e1-1.e34. https://doi.org/10.1016/j.ejca.2013.06.048 Clermonts SHEM, Köeter T, Pottel H, Stassen LPS, Wasowicz DK, Zimmerman DDE (2020) Outcomes of completion total mesorectal excision are not compromised by prior transanal minimally invasive surgery. Color Dis. https://doi.org/10.1111/codi.14962 Serra-Aracil X (2021) Completion surgery in unfavorable rectal cancer after transanal endoscopic microsurgery: does it achieve satisfactory sphincter preservation, quality of total mesorectal excision specimen, and long-term oncological outcomes? Dis Colon Rectum 64:200–208 Letarte F, Raval M, Karimuddin A, Phang PT, Brown CJ, Raval M, Karimuddin A, Phang PT, Brown CJ (2018) Salvage TME following TEM: a possible indication for TaTME. Tech Coloproctol 22:355–361. https://doi.org/10.1007/s10151-018-1784-3 Koedam TWA, van Ramshorst GH, Deijen CL, Elfrink AKE, Meijerink WJHJ, Bonjer HJ, Sietses C, Tuynman JB (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21:25–33. https://doi.org/10.1007/s10151-016-1570-z Bulut O, Gudbrand C, Pachler JH (2018) Transanal completion TME as early salvage surgery after TEM in rectal cancer-a short report. Clin Surg 3:2250 Maslekar S, Sharma A, MacDonald A, Gunn J, Monson JRT, Hartley JE (2007) Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum 50:168–175. https://doi.org/10.1007/s10350-006-0756-2 Jörgren F, Johansson R, Damber L, Lindmark G (2010) Risk factors of rectal cancer local recurrence: population-based survey and validation of the Swedish rectal cancer registry. Colorectal Dis 12:977–986. https://doi.org/10.1111/j.1463-1318.2009.01930.x