ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2021
The learning curve of transanal total mesorectal excision for rectal cancer is associated with local recurrence: results from a multicentre external audit.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Video-based tools for surgical quality assessment of technical skills in laparoscopic procedures: a systematic review.Surgical endoscopy · 2023Pooled it
- The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review.Surgical endoscopy · 2022Pooled it
- Multicenter phase II trial of transanal total mesorectal excision for rectal cancer: preliminary results.Surgical endoscopy · 2023Trial
- Repositioning transanal total mesorectal excision in the robotic era.Journal of robotic surgery · 2026Review
- Essential Updates 2024-2026: Advances in Colorectal Cancer Surgery.Annals of gastroenterological surgery · 2026Review
- Impact of Hospital Volume on Local Recurrence of Rectal Cancer After Transanal Total Mesorectal Excision: A Nationwide Multicenter Cohort Study in Japan.Annals of surgical oncology · 2026Article
- Learning Curve Effect in Reducing Local Recurrence Rate After Resection of Pancreatic Cancer With Arterial Abutment: A Single-Center Retrospective Study.Annals of gastroenterological surgery · 2026Article
- Robotic Intracorporeal Single-Stapled Anastomosis (RISS) is Associated with Lower Anastomotic Leakage Rates than the Double-Stapled Technique After Minimally Invasive Total Mesorectal Excision for Rectal Cancer.Annals of surgical oncology · 2026Article
- Benefit of laparoscopic two-team transanal beyond total mesorectal excision for advanced and recurrent rectal cancer with invasion: a retrospective study compared with conventional laparoscopic approach.Techniques in coloproctology · 2025Article
- Efficacy and long-term outcomes of abdominoperineal resection using transperineal total mesorectal excision approach for rectal cancer.Surgery today · 2025Article
- ESGE/ESGO/SERGS consensus statement on surgical steps in minimally invasive surgery in gynecologic oncology: transperitoneal and extraperitioneal approach for paraaortic lymphadenectomy.International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2024Article
- Transanal total mesorectal excision: short- and long-term results of four certified colorectal cancer centers in Germany.International journal of colorectal disease · 2024Article
- Oncologic outcomes following transanal total mesorectal excision: the United States experience.Surgical endoscopy · 2024Observational
- Local Recurrence of Rectal Cancer After Transanal Total Mesorectal Excision and Risk Factors: A Nationwide Multicenter Cohort Study in Japan.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer?Healthcare (Basel, Switzerland) · 2023Review
- Incidence and Risk Factors of Surgical Complications and Anastomotic Leakage After Transanal Total Mesorectal Excision for Middle and Low Rectal Cancer.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023Article
- Local recurrence of robot-assisted total mesorectal excision: a multicentre cohort study evaluating the initial cases.International journal of colorectal disease · 2022Article
- Transanal (TaTME) vs. laparoscopic total mesorectal excision for mid and low rectal cancer: a propensity score-matched analysis of early and long-term outcomes.International journal of colorectal disease · 2021Article
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTransanal total mesorectal excision (TaTME) has been suggested as a potential solution for the resection of challenging mid and low rectal cancer. This relatively complex procedure has been implemented in many centres over the last years, despite the absence of long-term safety data. Recently, concern has arisen because of an increase in local recurrence in the implementation phase. The aim of this study was to assess the correlation between accumulated experience and local recurrences.
methodAn independent clinical researcher performed an external audit of consecutive series of all TaTME procedures in six centres in the Netherlands. Kaplan-Meier estimated local recurrence rates were calculated and multivariate Cox proportional hazards regression analysis performed to assess risk factors for local recurrence. Primary outcome was the local recurrence rate in the initial implementation (cases 1-10), continued adoption (cases 11-40) and prolonged experience (case 41 onward).
resultsSix hundred and twenty-four consecutive patients underwent TaTME for rectal cancer with a median follow-up of 27 months (range 1-82 months). The estimated 2- and 3-year local recurrence rates were 4.6% and 6.6%, respectively. Cox proportional hazards regression revealed procedural experience to be an independent factor in multivariate analysis next to advanced stage (ycMRF+, pT3-4, pN+) and pelvic sepsis. Corrected analysis projected the 3-year local recurrence rates to be 9.7%, 3.3% and 3.5% for the implementation, continued adoption and prolonged experience cohorts, respectively.
conclusionThis multicentre study shows a high local recurrence rate (12.5%) after implementation of TaTME which lowers to an acceptable rate (3.4%) when experience increases. Therefore, intensified proctoring and further precautions must be implemented to reduce the unacceptably high risk of local recurrence at units starting this technique.
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