Rapport PROMs 'Inventarisatie en realisatie patiëntgerapporteerde uitkomsten 13 aandoeningen'
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Half december 2018 verscheen een publicatie met data uit de Dutch ColoRectal Audit (DCRA) in Journal of the American College of Surgeons.
Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision
Auteurs: Detering R, Roodbeen SX, van Oostendorp SE, Dekker JWT, Sietses C, Bemelman WA, Tanis PJ, Hompes R & Tuynman JB. (2019).
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TaTME is a relatively new, demanding technique for rectal cancer treatment. Results from national datasets are absent and comparative data with lapTME scarce. Therefore, this study aimed to evaluate the initial Transanal Total Mesorectal Excision (TaTME) experience in the Netherlands, by comparing outcomes with conventional laparoscopic TME (lapTME).
Patients with rectal cancer who underwent curative TaTME or lapTME were selected from the nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 and December 2017. Primary outcome was CRM involvement. Secondary outcomes included operative details and short-term (<30 days) clinical course. Propensity score matching was performed for seven factors.
3777 patients were included for analysis (TaTME=416, lapTME=3361). TaTME was performed in 38 hospitals and lapTME in 90 hospitals. Before matching, the patient category within the TaTME group was technically more challenging in terms of tumor height and pre-operative threatened margins. After 1:1 matching, 396 patients were included in each group, with comparable baseline characteristics. CRM involvement was 4.3% after TaTME and 4.0% after lapTME (p=1.000). Conversion rate was significantly lower in TaTME (1.5% vs. 8.6%, p<0.001). Anastomotic leak rate was not significantly different (16.5% vs. 12.2%, p=0.116). Other postoperative outcomes were also comparable between the groups. Significant independent risk factors for CRM involvement in TaTME were pre-operative threatened margin on MRI (OR 5.48, 95%CI 1.33-22.54) and conversion (OR 30.12, 95% CI 3.70-245.20).
This first nationwide study shows the early experience with adoption of TaTME in the Netherlands. Considering that current data represent initial TaTME experience, acceptable short-term outcomes were demonstrated when compared with the well-established lapTME.