Aim

The main objective of this study was to compare the oncological outcomes of patients undergoing abdominoperineal resection vs low anterior resection through a taTME approach.

Method

A total of 360 adult patients with a diagnosis of rectal cancer were enrolled at participating centers from the Canadian taTME Expert Collaboration. 43 patients received taTME-APR vs 317 taTME-LAR. Demographic, operative, pathologic, and follow-up data were collected and merged into a single database. Results are presented as hazards ratio (HR) and 95% confidence interval. All analyses were performed in the R environment (v3.6).

Results

The proportion of patients with a positive CRM status was higher in the taTME-APR group vs. the taTME-LAR group (21% vs. 9%, P = 0.001). Complete TME was achieved in 91% of those undergoing APR vs. 96% of those undergoing LAR (P = 0.25). APR was associated with a greater rate of local recurrence relative to LAR, although it was not significant (crude HR [95% CI]= 3.53 [0.92, 13.53]). Circumferential margin positivity was significantly associated with a higher rate of systemic recurrence (crude HR [95% CI]= 3.59 [1.38, 9.3])

Conclusion

Our results demonstrate inferior outcomes in those undergoing taTME APR compared with LAR. The use of this technique for this particular indication needs to be carefully considered.