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.

backgroundThe optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.

methodsThis single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).

resultsIn total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.

conclusionsLaparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.