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24.10.2017 | Ausgabe 3/2018

Surgical Endoscopy 3/2018

Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux’ randomized trial

Zeitschrift:
Surgical Endoscopy > Ausgabe 3/2018
Autoren:
Quentin Denost, Paula Loughlin, Remy Chevalier, Bertrand Celerier, Romain Didailler, Eric Rullier
Wichtige Hinweise
Presented as oral communication at the congress of European Society of Coloproctology (ESCP), Milan, September 28–30th, 2016.

Abstract

Aim

The aim of the current study is to report long-term outcomes after transanal low rectal dissection compared with the conventional laparoscopic approach within the context of the Bordeaux’ randomized trial. Results from this randomized trial have indicated that transanal approach was more effective than laparoscopic dissection regarding the rate of negative circumferential resection margin (CRM). Despite a high number of publications regarding the transanal approach for TME, there were no long-term data on survival and local recurrence which are now required.

Methods

One hundred patients with low rectal cancer suitable for laparoscopic TME with handsewn coloanal anastomosis were randomized in transanal versus laparoscopic low rectal dissection from 2008 to 2012. The randomization ratio was 1:1. All patients included in the trial were considered for long-term assessment. Local recurrence, overall- and disease-free survival were assessed by Kaplan–Meier and compared with Log-rank test.

Results

The follow up was 60.2 months, similar in both group (p = 0.321). Overall, there were no differences of long-term outcomes. There was a significant association between CRM involvement and local recurrence (p = 0.011), however, the 5-year local recurrence rate was 4%, without any significant difference between transanal and laparoscopic dissection: 3% vs. 5%; p = 0.300. The 5-year disease-free survival was 73%: 72% vs. 74; p = 0.351.

Conclusion

Lower positivity of the circumferential resection margin was reported after transanal low rectal dissection, but it did not translate into a decreased incidence of local recurrence. Further investigations are necessary to demonstrate advantages of this new procedure.

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