Transanal Minimally Invasive TME (TaTME) Versus Non-Endoscopic Transanal Intersphincteric Resection of Post-Neoadjuvant Ultralow Rectal Adenocarcinoma: A Multicentric, Matched Case-Control Study

The purpose of the research was to evaluate the outcomes of TaTME for ultralow anorectal adenocarcinoma. Functional, surgical and oncological outcomes were assessed. Of 160 ultralow rectal cancer patients, 110 cases were eligible and received anal sphincter preservation either by transanal total mesorectal excision (TaTME) or open Intersphincteric resection (O-ISR) from April 2013 to July 2022. A multicentric matched case control work was conducted in Oncology Centre of Mansoura University and Marche Polytechnic University of Ancona. ClinicalTrials.gov ID is NCT01836926. Intraoperative morbidity occurred in six cases (5.5%). Blood loss and blood transfusion rates had been substantially low in the TaTME contrasted to O-ISR. The median Open ISR time (240 +/- 97.3) was statistically shorter in O-ISR. Open conversions were conducted in five cases of TaTME. O-ISR had highly significant pain scores and a longer hospital stay than TaTME. Early postoperative consequences were greater in the open ISR group in comparison with TaTME group (19 versus 10 complications respectively) (P value = 0.012). The late postoperative complications, oncologic, and functional outcomes were comparable in both groups. TaTME is an efficient, highly challenging minimally invasive sphincter and continence sparing procedure with a high learning curve in extremely low rectal adenocarcinoma after neoadjuvant concurrent chemoradiotherapy.