eP271 - Transanal Total Mesorectal Excision: Outcomes of Community Based Practice

Purpose/Background: The treatment of rectal cancer has been drastically evolving over the years. Total mesorectal excision (TME) is the standard technique for surgical intervention in the treatment of rectal cancer. There have been randomized prospective clinical trials that have demonstrated improved perioperative outcomes without statistically significant local disease recurrence rates and overall survival from laparoscopic TME as compared to open TME. More recently, transanal TME (TaTME) has been adopted across large institutions. This technique combines a laparoscopic and transanal approach to facilitate resection of the rectum and mesorectum. TaTME is thought to be beneficial especially in cases with difficult anatomy including narrow pelvis, high BMI, large prostate, fatty mesorectum, fibrosis, and unfavorable tumor characteristics. There has been varying data in the literature regarding the TaTME technique and impact on local recurrence and overall survival. This study aims to determine the outcomes of TaTME at a single institution including rate of local recurrence and completeness of TME.Methods/Interventions: This study is a retrospective chart review of patients who have undergone TaTME at a single institution. Data collected includes patient characteristics, tumor characteristics, surgical variables, pathologic outcomes, local recurrence, and overall survival.Results/Outcomes: We reviewed patients from a single community-based institution between January 2019 to September 2023 who underwent TaTME for rectal cancer. There were a total of 26 patients who met inclusion criteria. 21 patients were male (80.7%). The average age was 61 years old and average BMI was 27.98. 19 patients had a complete TME (73%). 4 patients (15.38%) were found to have distant metastatic disease, 1 of these patients had local recurrence in pelvic lymph nodes. There were no 30 day mortalities.Conclusion/

Discussion: This study was able to evaluate data from 26 patients at a community-based institution undergoing TaTME for rectal cancer. Prior studies have shown some favorable outcomes using the TaTME technique in large volume tertiary care centers and our study aimed to see if these outcomes were reproducible in the community-based setting. We found local recurrence in only 1 patient (3.8%) to pelvic lymph nodes which is comparable to prior US studies and lower than local recurrence rates reported from other countries using TaTME technique. Of the four patients with distant recurrence, 2 of these patients were noted to have metastatic disease preoperatively that was treated with additional surgical resection. Limitations to this study include short follow up, single center study, retrospective design, and small sample size. However, this study demonstrates that TaTME can be used in the community-based setting for rectal cancer with similar local recurrence rates to higher volume tertiary care centers.