Evidence map›Paper›PMID 31602515›Full record

ArticleSurgical endoscopy2020

Transanal total mesorectal excision (taTME) for rectal cancer: beyond the learning curve.

Anthony P D'Andrea, Elisabeth C McLemore, Antoinette Bonaccorso, Jordan M Cuevas, Motahar Basam, Anna T Tsay, Deepika Bhasin, Vikram Attaluri, Patricia Sylla

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Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed.

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  14. The ACPGBI recommends pause for reflection on transanal total mesorectal excision.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Anthony P D'AndreaDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.ORCID 0000-0002-9855-2457
Elisabeth C McLemoreDepartment of Surgery, Los Angeles Medical Center, Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA.
Antoinette BonaccorsoDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.
Jordan M CuevasDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.
Motahar BasamDepartment of Surgery, Los Angeles Medical Center, Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA.
Anna T TsayDepartment of Surgery, Los Angeles Medical Center, Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA.
Deepika BhasinDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.
Vikram AttaluriDepartment of Surgery, Los Angeles Medical Center, Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA.
Patricia SyllaDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA. patricia.sylla@mountsinai.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTransanal total mesorectal excision (taTME) is a surgical approach for low rectal cancer with a learning curve estimated at 40-50 cases. The experience among taTME surgeons beyond their learning curve is limited.

methodsA retrospective analysis of all taTME cases performed for rectal cancer at two tertiary care hospitals from 2014 to 2019 was conducted. Transanal surgeons had previously performed > 50 taTME cases. Demographic, perioperative, and short-term outcomes were analyzed.

resultsAmong 54 taTME patients, 74.1% were male and 27.8% had a BMI ≥ 30. Tumors were stage I (8), II (13), III (29), and IV (4). Complex cases included 4 local recurrences, 4 prior liver resections, and 2 with prior prostate cancer. Thirty tumors were located ≤ 6 cm from the anal verge. On staging MRI, 12 had a positive predicted circumferential radial margin (+CRM), and 4 had internal anal sphincter involvement (+IAS). Forty-seven patients received neoadjuvant therapy. A 2-team approach was used in 51 patients with laparoscopic (83.3%) or robotic (16.7%) abdominal assistance with a 9.2% conversion rate. Low anterior resection with sphincter salvage was achieved in 87% with 8 patients requiring intersphincteric resection. Anastomoses were hand-sewn in 57.4% and all patients were diverted. Median LOS was 5 days with a 42.6% 30-day morbidity rate and 3 postoperative mortalities (ARDS, pulmonary embolism and pseudomembranous colitis). Complete and near complete TME grade was achieved in 94.4% with a 3.7% rate of +CRM. At a median follow-up of 28 months, local and distant recurrence rates were 3.9% and 17.6%, respectively, with no cancer-related mortality.

conclusionIndications for taTME at experienced centers have expanded to include complex reoperative cases, local recurrences, metastatic cancer, and tumors with threatened CRM or IAS with evidence of post-treatment tumor regression. In the latter cases, taTME achieves good short-term outcomes and may facilitate R0 resection.

Indexed as

Learning CurveTransanal Endoscopic SurgeryAgedAnal CanalFemaleHumansLaparoscopyLength of StayMagnetic Resonance ImagingMaleMargins of ExcisionMiddle AgedNeoplasm Recurrence, LocalNeoplasm StagingPostoperative ComplicationsRectal NeoplasmsLearning curveOncologic outcomesProctectomyRectal cancerSurvivalTransanal total mesorectal excision (taTME)

Identifiers

PMID31602515

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.