Open AccessTransanal total mesorectal excision for rectal cancer has been suspended in Norway
Author(s) -
Wasmuth H. H.,
Færden A. E.,
Myklebust T. Å.,
Pfeffer F.,
Norderval S.,
Riis R.,
Olsen O. C.,
Lambrecht J. R.,
Kørner H.,
Larsen S. G.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11459
Subject(s) - medicine , total mesorectal excision , anastomosis , colorectal cancer , surgery , stoma (medicine) , cancer registry , hazard ratio , norwegian , cohort , cancer , confidence interval , linguistics , philosophy
Background Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. Methods Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan–Meier estimates were used to compare local recurrence. Results In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7·6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2·4 years was 11·6 (95 per cent c.i. 6·6 to 19·9) per cent after TaTME compared with 2·4 (1·4 to 4·3) per cent in the NCCR ( P < 0·001). The adjusted hazard ratio was 6·71 (95 per cent c.i. 2·94 to 15·32). Anastomotic leaks resulting in reoperation occurred in 8·4 per cent of patients in the TaTME cohort compared with 4·5 per cent in NoRGast ( P = 0·047). Fifty‐six patients (35·7 per cent) had a stoma at latest follow‐up; 39 (24·8 per cent) were permanent. Conclusion Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.