ArticleSurgical endoscopy2026
Association between technical difficulty and patient prognosis after transanal total mesorectal excision for middle and low rectal cancer: a multicenter cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhether technical difficulty influences outcomes after transanal total mesorectal excision (TaTME) for middle and low rectal cancer remains unclear. This study evaluated the association between technical difficulty and patient outcomes.
methodsThis multicenter retrospective cohort study included 210 consecutive patients with middle and low rectal cancer who underwent TaTME at three centers in China. A five-item technical difficulty score was constructed using male sex, body mass index ≥ 25 kg/m
resultsOverall, 130 patients were classified into the low technical difficulty group and 80 into the high technical difficulty group. The high technical difficulty group had a longer operative time (249.0 ± 60.0 vs. 220.3 ± 50.1 min, P < 0.001), but major short-term outcomes did not differ significantly. The 3-year DFS and OS rates were 80.2% and 89.0%, respectively. Forty postoperative recurrences were recorded, mainly distant metastases, with most occurring within 2 years. Overall recurrence (17.7% vs. 21.2%, P = 0.588) and local recurrence (3.8% vs. 2.5%, P = 0.711) were comparable between groups. High technical difficulty was not independently associated with DFS (HR 1.06, 95% CI 0.57-2.00, P = 0.849) or OS (HR 1.21, 95% CI 0.52-2.81, P = 0.664).
conclusionTechnical difficulty in TaTME was mainly reflected by prolonged operative time and was not significantly associated with increased local recurrence or reduced 3-year DFS/OS. Early surveillance for systemic recurrence remains important.
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