Short-term Outcomes of Transanal Total Mesorectal Excision

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Presentation transcript:

Short-term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer: Experience of CMUH 廖庭儀柯道維蔡元耀黃郁純陳奕彰張伸吉江驊哲陳宏彰廖師賢王輝明陳自諒中國醫藥大學附設醫院大腸直腸肛門外科

Introduction Whether open or laparoscopic, TME is a difficult surgery.

Introduction Whether open or laparoscopic, TME is a difficult surgery.

Introduction Some consider perform TME from buttom to up.

safety and feasibility Aim safety and feasibility short-term outcomes

Material & Method n=51 Middle or low rectal cancer Jan. 2016 – Jan. 2018 CMU Hospital

Patient Characteristics Data Age, y, mean±SD 63.0±11.4 Male, n(%) 33 (64.71%) BMI, kg/m2, mean±SD 24.3±3.4 ASA score, n(%) II 31 (60.78%) III 20 (39.22%) Neoadjuvant CCRT, n(%) 34 (66.67%) Tumor location Middle rectum, n(%) 26 (50.98%) Low rectum, n(%) 25 (49.02%) By NCCN guideline, T3以上或any N, 做nCCRT

Preoperative TNM stage Data Stage, n(%) 1 (1.96%) I 9 (17.65%) II 5 (9.80%) III 26 (50.98%) IV 6 (11.76%) N/A 4 (7.84%)

Perioperative Outcomes Data Operation time, mins, mean±SD 324.0±104.6 Blood loss, ml, mean±SD 98.0±126.4 Conversion, n(%) 0 (0%) Protective stoma, n(%) 51 (100%) Anastomosis method Hand-sewn, n(%) 28 (54.90%) Staple, n(%) 23 (45.10%) Anastomosis site, cm FAV, mean±SD 2.6±1.0

Operation time, minutes Analysis Operation time, minutes Mean: 324.0

Perioperative Outcomes Data Intraoperative complications, n(%) 3 (1.96%) Left internal iliac artery injury 1 (1.96%) Rectal and vaginal perforation Urethral injury

Histopathological Characteristics Data Tumor size, cm, mean±SD 2.2±1.4 Distal margin, cm, mean±SD 1.8±1.3 Circumferential margin, mm, mean±SD 11.0±9.1 Circumferential resection margin(CRM) positive, n(%) 7 (13.73%) negative, n(%) 41 (80.39%) Total LN numbers, mean±SD 14.9±7.0 aim

Pathological Stage Data With nCCRT n=34 Complete response 8 (23.53%) I 4 (11.76%) II III 10 (29.41%) IV aim

Pathological Stage Data Without nCCRT n=17 1 (5.88%) I 6 (35.29%) II 1 (5.88%) I 6 (35.29%) II 2 (11.76%) III 4 (23.53%) IV N/A 3 (17.65%) aim

Postoperative Outcomes Data Hospital stay, days, mean±SD 6.6±2.7 Removal of Foley, POD, mean±SD 2.1±2.2 Re-catheterization, n(%) 9 (17.65%) Prolonged removal of Foley , n(%) 4 (7.84%) Anastomosis leakage, n(%) 8 (15.69%) Other complications Ileus, n(%) 1 (1.96%) UTI, n(%) 2 (3.92%) Recto-vaginal fistula, n(%)

Analysis Anastomotic leakage

Conclusion TaTME is an alternative approach for middle and low rectal cancer. It is feasible and safe. Complications, ex: urethral injury… TaTME is safe and feasible TaTME is not an easy procedure. Need experienced surgeon to perform. Platform