Comparison of Anastomotic Stricture/Stenosis After Transanal Total Mesorectal Excision for Rectal Cancer with Laparoscopic Total Mesorectal Excision

Anastomotic stricture/stenosis is an alarming complication developing after colorectal surgery. The purpose of this study was to compare the severity of anastomotic stricture/stenosis developing after transanal total mesorectal excision to that developing after laparoscopic total mesorectal excision. This research included patients with confirmed rectal adenocarcinoma who underwent transanal total mesorectal excision or laparoscopic total mesorectal excision with stapled anastomosis at Shengjing Hospital of China Medical University from March 2018 to June 2021. For comparison of anastomotic stricture/stenosis at 1, 3, and 6 months after surgery, a special stricture/stenosis grading system was adopted. A total of 41 patients (21 who underwent transanal total mesorectal excision and 20 who underwent laparoscopic total mesorectal excision, all with defunctioning stoma) received neoadjuvant radiotherapy, and 172 patients (86 patients underwent transanal total mesorectal excision, and the remaining 86 underwent laparoscopic total mesorectal excision, with 55 of the former and 49 of the latter receiving defunctioning stoma) did not receive radiotherapy which were enrolled in the study. The severity of the stricture was graded at 1, 3, and 6 months after surgery. For patients who did not receive radiotherapy, anastomotic stricture/stenosis developing after transanal total mesorectal excision was more severe than that developing after laparoscopic total mesorectal excision during the follow-up period (all p < 0.05), and such differences were always significant in cases with a defunctioning stoma (all p < 0.05) but not obvious in cases without a defunctioning stoma at 1 and 3 months after surgery (all p > 0.05). In case of patients who received radiotherapy, no difference was noted between the transanal total mesorectal excision and laparoscopic total mesorectal excision groups in terms of the degrees of anastomotic stricture/stenosis (all p > 0.05), and compared with patients who did not receive radiotherapy, more severe degrees of anastomotic stricture/stenosis were observed (all p < 0.05). During the short-term follow-up, the severity of anastomotic stricture/stenosis was higher after transanal total mesorectal excision with stapled anastomosis than after laparoscopic total mesorectal excision and mainly occurred in patients with a defunctioning stoma and those who did not receive radiotherapy. There was no differences between the two groups of patients who received radiotherapy in terms of severity.