Transanal total mesorectal excision versus transabdominal laparoscopic Low Hartmann's procedure for rectal cancer: A single-center retrospective analysis of short-term outcomes

IF 2.3 4区医学 Q2 SURGERY

Journal of Visceral Surgery Pub Date : 2026-02-01 Epub Date: 2026-03-04 DOI:10.1016/j.jviscsurg.2025.11.003

Jacques-Emmanuel Saadoun, Hélène Meillat, Eddy Traversari, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong

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引用次数: 0

Abstract

Aim

Low Hartmann's (LH) procedure for rectal cancer is indicated for frail patients with a high risk of anastomotic fistulas or poor functional outcomes. While transanal total mesorectal excision (TaTME) offers potential technical advantages over transabdominal laparoscopy, its clinical benefits are lacking. We aimed to evaluate whether TaTME improves short-term outcomes of the LH procedure compared with transabdominal laparoscopy.

Method

We retrospectively evaluated all patients who underwent laparoscopic LH procedures for mid or low rectal cancer at our center from 2010 to 2023. The primary endpoint was 90-day morbidity. The secondary endpoints included conversion rate, pelvic abscess rate, length of hospital stay (LHS), and oncological quality of resection.

Results

The baseline characteristics of the patients were comparable between the laparoscopic (Lap; n = 44) and TaTME (n = 31) groups. Severe morbidity was significantly lower in the TaTME group (3.2% vs. 23%; P = 0.04), with a lower pelvic abscess rate (9.6% vs. 25%, P = 0.04). Operative time was comparable, but conversion rate and blood loss were significantly lower in the TaTME group. LHS was shorter in the TaTME group (12.3 vs. 16.9 days; P = 0.03), with a comparable readmission rate. Pathologic outcomes, including resection margins and mesorectal quality, were comparable between the groups. Among patients with 3-year follow-up data, local recurrence occurred in 3 (7.6%) and 2 (7.7%) patients in the Lap and TaTME groups, respectively (P = 1).

Conclusion

The TaTME approach for the LH procedure can be a valuable option for rectal cancer management, as it reduces severe morbidity and hospital stay, without compromising oncologic outcomes.

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经肛直肠全系膜切除术与经腹腹腔镜Low Hartmann手术治疗直肠癌：短期结果的单中心回顾性分析

目的：低哈特曼（LH）手术治疗直肠癌适用于身体虚弱、吻合口瘘风险高或功能预后差的患者。虽然经肛门全肠系膜切除术（TaTME）与经腹腹腔镜相比具有潜在的技术优势，但其临床益处尚缺乏。我们的目的是评估TaTME与经腹腹腔镜相比是否能改善LH手术的短期结果。方法：我们回顾性评估2010年至2023年在本中心接受腹腔镜LH手术治疗中低位直肠癌的所有患者。主要终点为90天的发病率。次要终点包括转换率、盆腔脓肿率、住院时间（LHS）和肿瘤切除质量。结果：腹腔镜组（Lap, n=44）和TaTME组（n=31）患者的基线特征具有可比性。TaTME组严重发病率显著降低（3.2% vs. 23%， P=0.04），盆腔脓肿发生率较低（9.6% vs. 25%， P=0.04）。手术时间比较，但转换率和出血量明显低于TaTME组。TaTME组LHS较短（12.3天vs. 16.9天；P=0.03），再入院率相当。病理结果，包括切除边缘和肠系膜质量，在两组之间具有可比性。随访3年的患者中，Lap组3例（7.6%）局部复发，TaTME组2例（7.7%）局部复发（P=1）。结论：TaTME方法用于LH手术是直肠癌治疗的一个有价值的选择，因为它减少了严重的发病率和住院时间，而不影响肿瘤预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Visceral Surgery SURGERY-

CiteScore

2.00

自引率

9.50%

发文量

108

审稿时长

>12 weeks

期刊介绍： The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization. JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.