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Background: The oncologic safety of transanal total mesorectal excision (TaTME) for rectal cancer has recently been questioned, with high local recurrence (LR) rates reported in Dutch and Norwegian experiences. The objective of this study was to evaluate the oncologic safety of TaTME in a large cohort of patients with primary rectal cancer, primarily in terms of LR, disease-free survival (DFS), and overall survival (OS). Patients and methods: This was a prospective international registry cohort study, including all patients who underwent TaTME for primary rectal adenocarcinoma from February 2010 through December 2018. The main endpoints were 2-year LR rate, pattern of LR, and independent risk factors for LR. Secondary endpoints included 2-year DFS and OS rates. Kaplan-Meier survival analysis was used to calculate actuarial LR, DFS, and OS rates. Results: A total of 2,803 patients receiving primary TaTME were included, predominantly men (71%) with a median age of 65 years (interquartile ratio, 57-73 years). After a median follow-up of 24 months (interquartile ratio, 12-38 months), the 2-year LR rate was 4.8% (95% CI, 3.8%-5.8%) with a unifocal LR pattern in 99 of 103 patients (96%). Independent risk factors for LR were male sex, threatened resection margin on baseline MRI, pathologic stage III cancer, and a positive circumferential resection margin on final histopathology. The 2-year DFS and OS rates were 77% (95% CI, 75%-79%) and 92% (95% CI, 91%-93%), respectively. Conclusions: This largest TaTME cohort to date supports the oncologic safety of the TaTME technique for rectal cancer in patients treated in units that contributed to an international registry, with an acceptable 2-year LR rate and a predominantly unifocal LR pattern.
Local Recurrence and Disease-Free Survival After Transanal Total Mesorectal Excision: Results From the International TaTME Registry
M. Adamina;F. Aignerm;H. Al Furajii;A. Arezzo;S. J. Arnold;K. Aryal;R. Austin;O. Baekkelund;I. Baloyiannis;D. Bandyopadhyay;B. Banky;G. Barugola;E. E. Basany;E. H. J. Belgers;S. Bell;W. Bemelman;S. Berti;M. Biebl;B. Bloemendaal;L. Boni;R. J. I. Bosker;B. Box;C. Brown;L. Bruegger;W. Brunner;C. Buchli;R. Cahill;J. P. Campana;F. di Candido;G. T. Capolupo;M. Caricato;A. Caro-Tarragó;M. Casati;E. Cassinotti;M. Chadwick;P. Chitsabesan;D. Christoforidis;E. Coetzee;J. Coget;P. Collera;E. Courtney;C. Cunningham;F. Dagbert;S. J. Dalton;M. P. Damieta;G. Dapri;S. Dayal;N. de Manzini;K. de Pooter;B. DeLacy;S. Delgado;D. Dimitrov;S. Duff;K. E. Dzhumabaev;T. Edwards;M. Egenvall;L. Estevez-Schwarz;A. E. Færden;S. Faes;C. Feleppa;A. Ferrero;H. Forsmo;C. D. Freitas;A. Frontali;B. Gamage;L. J. García-Florez;D. Geissmann;M. Glöckller;S. Gloor;T. Grolich;D. Hahnloser;A. Harikrishnan;H. Hasegawa;I Haunold;M. F. Hevia;J. Hol;J. Horwood;R. Ial;M. Ito;G. P. S. Julião;M. Karamanliev;S. Killeen;W. Kneist;S. Y. Kok;S. Korsgen;M. Kusters;A. la Terra;A. Lacy;L. Lakatos;J. R. Lambrecht;S. Lavik;L. Lee;S. A. Liberman;L. Lorenzon;P. Mackey;Z. Z. Mamedli;T. Marcy;T. Maroon;L. Marti;P. Massucco;A. E. Mattacheo;I. McCallum;J. Meyer;A. Michalopoulos;S. Mikalauskas;Y. Miroshnychenko;C. Mitermair;T. Moore;B. Mooslechner;M. Morino;C. Muñoz. A. Muratore;V. M. Mutafchiyski;A. Myers;J. Navarro;D. Nicol;D. Nishizaki;G. J. Nolan;A. Ochsner;J. H. Oh;E. Osenda;S. Ourô;Y. Panis;T. Papavramidis;M. Paraoan;C. Pastor;C. F. W. Pei;D. Penchev;M. Pera;S. Perdawood;R. O. Perez;R. Persiani;F. Pfeffer;P. T. Phang;E. Poskus;F. Ris;T. A. Rockall;J. M. Romero-Marcos;P. Roquete;G. Rossi;G. Ruffo;M. G. Ruiz;J. Sagar;Y. Sakai;L. Sanchon;A. Scala;D. Schaap;M. M. Scheiding;M. Schiavo;E. M. Schmidt;G. Sevá-Pereira;R. Sguinzi;M. Shalaby;A. Sharma;G. Shashank;C. Sietses;P. Sileri;A. Slesser;D. K. Sohn;A. Solis-Peña;C. Soravia;M. M. N. Sosef;A. Spinelli;S. P. Storms;P. Studer;E. Syk;A. K. Talsma;P. Tejedor;S. Temple;J. Tognelli;W. Tong;J. Torkington;J. J. Tuech;G. Tzovaras;D. Van de Putte;Y. van Nieuwenhove;M. von Papen;S. Vorburger;Q. Wang;S. Warrier;H. Weiss;J. A. Witzig;T. Wolff;G. Wynn;U. Zingg
2021-01-01
Abstract
Background: The oncologic safety of transanal total mesorectal excision (TaTME) for rectal cancer has recently been questioned, with high local recurrence (LR) rates reported in Dutch and Norwegian experiences. The objective of this study was to evaluate the oncologic safety of TaTME in a large cohort of patients with primary rectal cancer, primarily in terms of LR, disease-free survival (DFS), and overall survival (OS). Patients and methods: This was a prospective international registry cohort study, including all patients who underwent TaTME for primary rectal adenocarcinoma from February 2010 through December 2018. The main endpoints were 2-year LR rate, pattern of LR, and independent risk factors for LR. Secondary endpoints included 2-year DFS and OS rates. Kaplan-Meier survival analysis was used to calculate actuarial LR, DFS, and OS rates. Results: A total of 2,803 patients receiving primary TaTME were included, predominantly men (71%) with a median age of 65 years (interquartile ratio, 57-73 years). After a median follow-up of 24 months (interquartile ratio, 12-38 months), the 2-year LR rate was 4.8% (95% CI, 3.8%-5.8%) with a unifocal LR pattern in 99 of 103 patients (96%). Independent risk factors for LR were male sex, threatened resection margin on baseline MRI, pathologic stage III cancer, and a positive circumferential resection margin on final histopathology. The 2-year DFS and OS rates were 77% (95% CI, 75%-79%) and 92% (95% CI, 91%-93%), respectively. Conclusions: This largest TaTME cohort to date supports the oncologic safety of the TaTME technique for rectal cancer in patients treated in units that contributed to an international registry, with an acceptable 2-year LR rate and a predominantly unifocal LR pattern.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/73845
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2021-2023 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.