Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Ximo Xu; Zhenghao Cai; Hong Zhang; Qing Xu; Mingyang Ren; Abe Fingerhut; Dachong Sha; Minhua Zheng; Jianwen Li; Yang Deng; Xiao Yang; Sen Zhang; Batuer Aikemu; Wei Qin; Duohuo Shu; Xinxiang Li; Jun You; Quan Wang; Bo Feng

doi:10.21037/atm-22-1693

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Ann Transl Med. 2022 Apr;10(8):489. doi: 10.21037/atm-22-1693.

Authors

Ximo Xu^#¹, Zhenghao Cai^#¹, Hong Zhang^#², Qing Xu^#³, Mingyang Ren^#⁴, Abe Fingerhut^{1

5}, Dachong Sha⁶, Minhua Zheng¹, Jianwen Li¹, Yang Deng¹, Xiao Yang¹, Sen Zhang¹, Batuer Aikemu¹, Wei Qin¹, Duohuo Shu¹, Xinxiang Li⁷, Jun You⁸, Quan Wang⁹, Bo Feng¹

Affiliations

¹ Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China.
³ Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.
⁵ Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
⁶ Department of General Surgery, The Third People's Hospital Health Care Group of Cixi, Ningbo, China.
⁷ Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
⁸ Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China.
⁹ Department of Gastric and Colorectal Surgery, the First Affiliated Hospital of Jilin University, Changchun, China.

^# Contributed equally.

Abstract

Background: Transanal total mesorectal excision (TaTME) is an alternative for mid-low rectal cancer. In China, this procedure has been performed in high-volume centers with structured training curriculums. The efficacy of the TaTME structured training curriculums in China is still unclear. This multicenter study aimed to explore the effectiveness of the structured training curriculums in China.

Methods: Seven high-volume centers in China participated in this study. The first 25 patients who underwent TaTME in each center were enrolled. In the cohort, patients were divided into 3 groups. The first 5 procedures (group 1) were performed under proctoring according to the requirement of structured training curriculums. The latter 20 cases without proctoring were split into 2 groups (10 cases in each group, groups 2 and 3) according to the order of operation date. The baseline characteristics, perioperative complications, and pathological outcomes were compared between groups 1 and 2, as well as between groups 2 and 3.

Results: Symptomatic anastomotic leakage (AL) occurred in 18.6% of the patients in group 2 compared with 5.7% in group 1 (P₁=0.08) and 5.0% in group 3 (P₂=0.04). Seven (11.3%) patients in group 2 developed defecation disorders whereas no patients had this complication in group 3 (P₂=0.02). Compared with group 2, the operative time was shorter (235 vs. 223 min, P₂=0.40), while the rates of intraoperative complications (15.7% vs. 5.7%, P₂=0.10), postoperative complications (31.3% vs. 25.7%, P₂=0.06), AL (20.0% vs. 8.6%, P₂=0.04), and positive distal resection margin (DRM) (7.5% vs. 2.9%, P₂=0.27) were lower in group 3.

Conclusions: The effect of the structured training curriculums was acceptable but needed further improvement. The prevalence of anastomosis-related complications and the quality control of specimens are still not optimal, and measures for refinement (for example, more cases under proctoring) are needed in the curriculums.

Keywords: Rectal neoplasms; short-term outcomes; structured training curriculums; transanal total mesorectal excision (TaTME).