Benefit of Laparoscopic Two-team Transanal Beyond Total Mesorectal Excision for Advanced and Recurrent Rectal Cancer with Invasion: A Retrospective Study Compared with Conventional Laparoscopic Approach

Abstract

Background The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with invasive rectal cancer.Methods This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to May 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal excision beyond total mesorectal excision were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).Results A total of 35 patients were included in the study. More patients underwent preoperative treatment and lateral lymph node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group (28% and 0%, p = 0.019), and STC was comparable between the groups. There was no increase in postoperative mortality or morbidity. Surgical complexity did not affect the outcomes of the transanal approach. Patients with surgical difficulties had shorter operative times and comparable STC between the two groups.Conclusions Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.