title: Short- and Mid-Term Outcomes after Endoscopic Transanal or Laparoscopic Transabdominal Total Mesorectal Excision for Low Rectal Cancer: A Single Institutional Case-Control Study.
abstract: BACKGROUND
  Transabdominal laparoscopic proctectomy (LAP) for rectal cancer was associated with postoperative recovery improvement. Early studies showed favorable short-term results of endoscopic transanal proctectomy (ETAP), with low conversion rates to open procedures. We aimed to compare efficacy, morbidity, and functional outcomes of ETAP to standard LAP for low rectal cancer.
  
  
  METHODS
  From 2008 to 2013, 72 consecutive patients received proctectomy and coloanal manual anastomosis for low rectal adenocarcinoma. Thirty-four patients had transanal endoscopic proctectomy, and 38 patients underwent the standard laparoscopic procedure.
  
  
  RESULTS
  When compared with the LAP group, the ETAP group demonstrated a lower conversion rate to open procedures (23.7% vs 2.9%, respectively; p = 0.015), shorter in-hospital stays (9 vs 8 days, respectively; p = 0.04), and a lower readmission rate (13.2% vs 0%; p = 0.03). Overall postoperative morbidity rates for the LAP and the ETAP groups (36.8% vs 32.4%, respectively; p = 0.69) and functional results (Kirwan score 1/2, 73.7% vs 73.5%, respectively; p = 0.85) were comparable; additionally, we found similar oncologic quality criteria (R1 resection 10.5% vs 5.9%, respectively; p = 0.68; grade 3 mesorectal integrity 52.6% vs 55.9%, respectively; p = 0.66). Disease-free survival of 24 months (Kaplan-Meier estimation) was comparable in the 2 groups: 86% in the ETAP group vs 88% in the LAP group; p = 0.91. At the date of last follow-up, 91.2% of ETAP patients and 92.1% of LAP patients were free of stoma.
  
  
  CONCLUSIONS
  The endoscopic transanal approach could facilitate mesorectal excision and improve short-term outcomes without impairing the oncologic quality of the resection or mid-term functional and oncologic results.
authors.affiliation: Department of Digestive Surgical Oncology, Paoli Calmettes Institute, Marseille, France Department of Biopathology, Paoli Calmettes Institute, Marseille, France Department of Clinical Research and Innovation, Biostatistics and Methodology Unit, Paoli Calmettes Institute, Marseille, France INSERM Unit U1124, Paris V-Descartes University, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Hélène
authors.initials: H
authors.lastname: Meillat
authors.forename: Christophe
authors.initials: C
authors.lastname: Zemmour
authors.forename: Flora
authors.initials: F
authors.lastname: Poizat
authors.forename: Jacques
authors.initials: J
authors.lastname: Ewald
authors.forename: Diane
authors.initials: D
authors.lastname: Mege
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Lelong
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Delpero
authors.forename: Cécile
authors.initials: C
authors.lastname: de Chaisemartin
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D000067368:Transanal Endoscopic Surgery; D016896:Treatment Outcome; D055815:Young Adult