TY - JOUR
AU - Heriot, A
AB - Editor We read with great interest the publication by Wasmuth et al.1, expressing concerns regarding the oncological safety of transanal total mesorectal excision (TaTME). The authors should be commended for their honest appraisal of this technique and for highlighting potential risks with pneumo-insufflation or exfoliating cancer cells into the pelvic cavity, and the dangers that this entails. As a high-volume rectal cancer centre that has successfully implemented TaTME in our programme, along with open, laparoscopic and robotic abdominal strategies, we believe the data highlight a phenomenon not too dissimilar to port sight metastases in laparoscopic surgery. The low rate of uptake of preoperative radiation (we understand the UK mercury data) is also in contrast to most centres in Australia and the USA. Particularly startling were the cases that recurred which included a T3 N1 tumour 3 cm from the anal verge, and two T3 tumours 5 cm from the anal verge (one with a sub-millimetre distal margin and one with a positive circumferential margin (CRM)). The T4a N2 tumour with the positive margin is also in this group. All these patients would usually receive preoperative radiation independent of radiological CRM status as the mesorectum is not bulky at those levels (and all were male). The surgical approach is a component of multidisciplinary care and a different approach does not compensate for the underlying pathology. Also, of interest was the very high rate of pathologically positive or sub-millimetre CRM at 12·7 per cent. This figure is not in keeping with most specialist centres and particularly in places where no radiation is provided in patients with mid and low rectal cancers. There is a distinct learning curve for TaTME with a skillset that mandates competence in intersphincteric resections, single port surgery and transanal endoscopic microsurgery/transanal minimally invasive surgery procedures. Our experience is that it is not appropriate for all surgical skillsets irrespective of years of colorectal practice. Again, the patients selected for these surgeons' learning curve were probably not appropriate. We feel that the technique does have a role to play in the management of distal rectal cancer in appropriately selected patients, and with appropriate training and credentialing for the surgeons. References 1 Wasmuth HH , Faerden AE, Myklebust TÅ, Pfeffer F, Norderval S, Riis R et al. ; Norwegian TaTME Collaborative Group, on behalf of the Norwegian Colorectal Cancer Group . Transanal total mesorectal excision for rectal cancer has been suspended in Norway . Br J Surg 2020 ; 107 : 121 – 130 . Google Scholar Crossref Search ADS PubMed WorldCat © 2020 BJS Society Ltd Published by John Wiley & Sons Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2020 BJS Society Ltd Published by John Wiley & Sons Ltd
TI - Comments on: Transanal total mesorectal excision for rectal cancer has been suspended in Norway
JF - British Journal of Surgery
DO - 10.1002/bjs.11597
DA - 2020-05-04
UR - https://www.deepdyve.com/lp/oxford-university-press/comments-on-transanal-total-mesorectal-excision-for-rectal-cancer-has-aDfWJlb7n0
SP - e221
EP - e221
VL - 107
IS - 7
DP - DeepDyve
ER -