Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation Therapy

BACKGROUND:The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in patients with low rectal cancers after preoperative radiation therapy. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter-preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted.OBJECTIVE:To assess local recurrence and survival after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation therapy.DESIGN:Retrospective cohort study of a prospectively maintained database.SETTINGS:Tertiary rectal cancer referral center.PATIENTS:Patients with low adenocarcinoma (<= 5 cm anorectal ring) receiving neoadjuvant chemoradiation therapy and then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998 and 2021.MAIN OUTCOME MEASURES:Local recurrence rates and overall survival rates.RESULTS:Of 255 included patients, 67.8% were men (n = 173); the mean age was 58.7 years (SD 11.5) and the mean BMI was 27.1 (SD 5.4), with 50.2% (n = 128) having ASA class II and 49.8% (n = 127) having ASA class III/IV. The mean tumor size was 4.8 cm (SD 1.9), the majority of patients had clinical T3 disease (81.8%; n = 184), and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response and 90.2% (n = 230) receiving minimally invasive surgery. The complete total mesorectal excision rate was 94.3%, and 100% of patients (n = 255) had negative distal margins. The mean number of examined lymph nodes were 13.9 (SD 10.7). After a median follow-up of 55.4 months, 5.1% of patients (n = 13) developed local recurrence at a median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI, 78.8-89.4).LIMITATIONS:Retrospective review with risk of bias and lack of generalizability.CONCLUSIONS:In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter-preserving surgery technique. See Video Abstract.ANaLISIS LONGITUDINAL DE LA RECURRENCIA LOCAL Y LA SUPERVIVENCIA DESPUeS DE LA PROCTOSIGMOIDECTOMiA RADICAL TRANSANAL ABDOMINAL (TATA) PARA EL CaNCER DE RECTO BAJO TRATADO CON QUIMIORRADIACI & Oacute; N NEOADYUVANTEANTECEDENTES:La proctosigmoidectomia radical transanal abdominal se desarrollo en 1984 como una cirugia de preservacion del esfinter en canceres de recto bajo despues de la radiacion preoperatoria. Si bien sirve como catalizador para la cirugia disruptiva de preservacion del esfinter, continua utilizandose y evolucionando. Con la controversia sobre la seguridad y la recurrencia local en otras cirugias que preservan el esfinter, se justifica la revision de los resultados oncologicos a largo plazo de la proctosigmoidectomia radical transanal abdominal.OBJETIVO:Evaluar localmente despues de Proctosigmoidectomia Radical Transanal Abdominal Transanal despues de quimiorradiacion neoadyuvante.DISENO:Estudio de cohorte retrospectivo de una base de datos mantenida de forma prospectiva.AJUSTES:Centro terciario de referencia para el cancer de recto. PACIENTES:Adenocarcinoma bajo (=/更多