Transanal Total Mesorectal Excision: Short-term Outcomes of 1283 Cases from a Nationwide Registry in China

BACKGROUND: Transanal total mesorectal excision is a promising surgical procedure for mid to low rectal cancer. OBJECTIVE: This study aimed to determine the short-term outcomes of Chinese patients treated with transanal total mesorectal excision. DESIGN: This was an observational study using data from an online registry system. SETTING: Study participants were recruited from 40 different centers across 15 provinces in China. PATIENTS: Patients with either benign or malignant rectal disease who underwent transanal total mesorectal excision procedure and were registered in the Chinese Transanal Total Mesorectal Excision Registry Collaborative from May 2010 to November 2019 were included. INTERVENTION: Patients underwent transanal total mesorectal excision. MAIN OUTCOME MEASURES: The primary outcomes measured were the postoperative complications and pathological outcomes. RESULTS: In total, 1283 patients, comprising 888 men (69.2%) and 395 women (39.8%) with a median age of 61 (22-92) years and a median BMI of 23.6 (14.5-46.3) kg/m(2), were analyzed. Among 40 participating centers, the average number of registered cases was 32.1 +/- 34.7, and 12 centers (30%) registered >40 cases in the registry. Among 849 patients with rectal cancer who underwent laparoscopic-assisted transanal total mesorectal excision, the conversion rate was 0.5% in the abdominal phase and 1.9% in the perineal phase. Three patients reported urethral injury (0.5%). The postoperative complication rate and the anastomotic leakage incidence were 18.4% and 5.8%. The quality of the total mesorectum excision specimens was found to be complete in 81.9% of patients. In addition, the positive circumferential resection margin rate was 2.8%. LIMITATIONS: The primary limitation of this registry study was the high percentage of missing data (10.8% overall), and, for some of the analyzed variables, up to 35% of the data was missing. Postoperative complications were not monitored after discharge, resulting in a lower morbidity rate than the 30-day morbidity rate reported in other studies. CONCLUSIONS: The short-term outcomes of patients who underwent transanal total mesorectal excision procedures in China were acceptable. See Video Abstract at http://links.lww.com/DCR/B414.