Transanal (TaTME) vs. laparoscopic total mesorectal excision for mid and low rectal cancer: a propensity score-matched analysis of early and long-term outcomes

Purpose: Transanal total mesorectal excision (TaTME) has been proposed as an alternative to laparoscopic total mesorectal excision (LapTME) in distal rectal tumors. Despite encouraging reports, mid- and long-term oncological results are limited. In this study, we aimed at comparing TaTME versus LapTME in patients with mid and low rectal cancer.

Methods: From January 2012 to December 2019, all patients undergoing either TaTME or LapTME for rectal adenocarcinoma ≤ 12 cm from the anal verge were included. Demographic, clinical, and follow-up data were retrieved from a prospective and audited database, and a propensity score-matched analysis was performed.

Results: A total of 144 patients were included, 38 underwent TaTME, and 106 LapTME. The median age was 68.0 (60.2-75.8) years, and 96 (66.7%) patients were male. Median follow-up was 30.6 (20.2-39.8) months in the TaTME group and 49.5 (22.6-68.5) months in the LapTME group. There was one (2.6%) local recurrence in the TaTME group and two (1.9%) in the LapTME group (p = 0.788). There was no difference in the 3-year disease-free survival between groups both in the primary (93% vs. 86%, p = 0.274) and the propensity score-matched analyses (93% vs. 81%, p = 0.132). Conversion to open surgery was less frequent in the TaTME group (none vs. 4 (11.4%), p = 0.041). Intra- and postoperative complications, length of stay, specimen quality, and resection margins were similar between groups.

Conclusions: In our experience, TaTME was associated with a less frequent conversion to open surgery but otherwise had similar post-operative results compared to LapTME. Local recurrence and 3-year survival rates were similar.