{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:48:48Z","timestamp":1792464528799,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Tech Coloproctol"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Transanal total mesorectal excision (TaTME) for mid and low rectal cancer has been shown to improve short-term outcomes, mostly due to lower conversion rates and with improved quality of the specimen. However, robust long-term oncological data supporting the encouraging clinical and pathological outcomes are lacking.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All consecutive patients undergoing TaTME with curative intent for mid or low rectal cancer in two referral centers in The Netherlands between January 2012 and April 2016 with a complete and minimum follow-up of 36\u00a0months were included. The primary outcome was local recurrence rate. Secondary outcomes were disease-free survival, overall survival and development of metastasis.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 159 consecutive patients. Their mean age was 66.9 (10.2) years and 66.7% of all patients were men. Pathological analysis showed a complete mesorectum in 139 patients (87.4%), nearly complete in 16 (10.1%) and an incomplete mesorectum in 4 (2.5%). There was involvement of the CRM (&lt;\u20091\u00a0mm) in one patient (0.6%) and no patients had involvement of the distal margin (&lt;\u20095\u00a0mm). Final postoperative staging after neoadjuvant therapy was stage 0 in 11 patients (6.9%), stage I in 73 (45.9%), stage II in 31 (19.5%), stage III in 37 (23.3%) and stage IV in 7 (4.4%). The 3-year local recurrence rate was 2.0% and the 5-year local recurrence rate was 4.0%. Median time to local recurrence was 19.2\u00a0months. Distant metastases were found in 22 (13.8%) patients and were diagnosed after a median of 6.9\u00a0months (range 1.1\u201350.4) months. Disease-free survival was 92% at 3\u00a0years and 81% at 5\u00a0years. Overall survival was 83.6% at 3\u00a0years and 77.3% at 5\u00a0years.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The long-term follow-up of the current cohort confirms the oncological safety and feasibility of TaTME in two high volume referral centers for rectal carcinoma. However, further robust and audited data must confirm current findings before widespread implementation of TaTME.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10151-019-02094-8","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T10:26:50Z","timestamp":1570703210000},"page":"903-911","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":101,"title":["Long-term oncological results after transanal total mesorectal excision for rectal carcinoma"],"prefix":"10.1007","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4481-7250","authenticated-orcid":false,"given":"Jeroen C.","family":"Hol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6969-7956","authenticated-orcid":false,"given":"Stefan E.","family":"van Oostendorp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5952-8000","authenticated-orcid":false,"given":"Jurriaan B.","family":"Tuynman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7777-1688","authenticated-orcid":false,"given":"Colin","family":"Sietses","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"issue":"5","key":"2094_CR1","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1007\/s00464-010-0965-6","volume":"24","author":"P Sylla","year":"2010","unstructured":"Sylla P et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205\u20131210","journal-title":"Surg Endosc"},{"issue":"2","key":"2094_CR2","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1007\/s00464-015-4221-y","volume":"30","author":"MV Helbach","year":"2016","unstructured":"Helbach MV et al (2016) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 30(2):464\u2013470","journal-title":"Surg Endosc"},{"issue":"12","key":"2094_CR3","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s10151-016-1545-0","volume":"20","author":"CL Deijen","year":"2016","unstructured":"Deijen CL et al (2016) Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 20(12):811\u2013824","journal-title":"Tech Coloproctol"},{"issue":"3","key":"2094_CR4","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1007\/s00464-018-6527-z","volume":"33","author":"X Zhang","year":"2019","unstructured":"Zhang X et al (2019) Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis. Surg Endosc 33(3):972\u2013985","journal-title":"Surg Endosc"},{"issue":"10","key":"2094_CR5","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1002\/bjs.1800691019","volume":"69","author":"RJ Heald","year":"1982","unstructured":"Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery\u2013the clue to pelvic recurrence? Br J Surg 69(10):613\u2013616","journal-title":"Br J Surg"},{"issue":"2","key":"2094_CR6","first-page":"194","volume":"373","author":"HJ Bonjer","year":"2015","unstructured":"Bonjer HJ et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 373(2):194","journal-title":"N Engl J Med"},{"issue":"4","key":"2094_CR7","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/SLA.0000000000003021","volume":"269","author":"ARL Stevenson","year":"2019","unstructured":"Stevenson ARL et al (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg 269(4):596\u2013602","journal-title":"Ann Surg"},{"issue":"4","key":"2094_CR8","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1097\/SLA.0000000000003002","volume":"269","author":"J Fleshman","year":"2019","unstructured":"Fleshman J et al (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage ii to iii rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269(4):589\u2013595","journal-title":"Ann Surg"},{"issue":"4","key":"2094_CR9","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1007\/s10151-018-1771-8","volume":"22","author":"TWA Koedam","year":"2018","unstructured":"Koedam TWA et al (2018) Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol 22(4):279\u2013287","journal-title":"Tech Coloproctol"},{"issue":"9","key":"2094_CR10","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1002\/bjs.11287","volume":"106","author":"SG Larsen","year":"2019","unstructured":"Larsen SG et al (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg 106(9):1120\u20131121","journal-title":"Br J Surg"},{"issue":"5","key":"2094_CR11","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.jamcollsurg.2016.12.019","volume":"224","author":"B Lelong","year":"2017","unstructured":"Lelong B et al (2017) Short- and mid-term outcomes after endoscopic transanal or laparoscopic transabdominal total mesorectal excision for low rectal cancer: a single institutional case-control study. J Am Coll Surg 224(5):917\u2013925","journal-title":"J Am Coll Surg"},{"issue":"6","key":"2094_CR12","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1111\/codi.13263","volume":"18","author":"JP Burke","year":"2016","unstructured":"Burke JP et al (2016) Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 18(6):570\u2013577","journal-title":"Colorectal Dis"},{"issue":"2","key":"2094_CR13","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.jamcollsurg.2015.03.046","volume":"221","author":"AM Lacy","year":"2015","unstructured":"Lacy AM et al (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221(2):415\u2013423","journal-title":"J Am Coll Surg"},{"issue":"4","key":"2094_CR14","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1097\/DCR.0b013e3182756fa0","volume":"56","author":"P Rouanet","year":"2013","unstructured":"Rouanet P et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56(4):408\u2013415","journal-title":"Dis Colon Rectum"},{"issue":"8","key":"2094_CR15","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1007\/s00423-015-1350-7","volume":"400","author":"N de\u2019Angelis","year":"2015","unstructured":"de\u2019Angelis N et al (2015) Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbecks Arch Surg 400(8):945\u2013959","journal-title":"Langenbecks Arch Surg"},{"issue":"5","key":"2094_CR16","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.ejso.2009.11.011","volume":"36","author":"M Kusters","year":"2010","unstructured":"Kusters M et al (2010) Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol 36(5):470\u2013476","journal-title":"Eur J Surg Oncol"},{"issue":"7","key":"2094_CR17","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1200\/JCO.2002.07.010","volume":"20","author":"ID Nagtegaal","year":"2002","unstructured":"Nagtegaal ID et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729\u20131734","journal-title":"J Clin Oncol"},{"issue":"12","key":"2094_CR18","doi-asserted-by":"publisher","first-page":"3494","DOI":"10.1007\/s00464-014-3636-1","volume":"28","author":"S Velthuis","year":"2014","unstructured":"Velthuis S et al (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28(12):3494\u20133499","journal-title":"Surg Endosc"},{"issue":"5","key":"2094_CR19","doi-asserted-by":"publisher","first-page":"41","DOI":"10.21037\/ales.2018.04.02","volume":"3","author":"SE van Oostendorp","year":"2018","unstructured":"van Oostendorp SE et al (2018) Transanal total mesorectal excision compared to laparoscopic TME for mid and low rectal cancer\u2014current evidence. Ann Laparosc Endosc Surg 3(5):41\u201349","journal-title":"Ann Laparosc Endosc Surg"},{"issue":"3","key":"2094_CR20","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1007\/s00464-017-5990-2","volume":"32","author":"M Adamina","year":"2018","unstructured":"Adamina M et al (2018) St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 32(3):1091\u20131103","journal-title":"Surg Endosc"},{"key":"2094_CR21","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-06750-w","author":"MV Helbach","year":"2019","unstructured":"Helbach MV et al (2019) Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in The Netherlands. Surg Endosc. \n                    https:\/\/doi.org\/10.1007\/s00464-019-06750-w","journal-title":"Surg Endosc"},{"issue":"1","key":"2094_CR22","doi-asserted-by":"publisher","first-page":"O1","DOI":"10.1111\/codi.13964","volume":"20","author":"SC Abbott","year":"2018","unstructured":"Abbott SC et al (2018) An assessment of an Australasian pathway for the introduction of transanal total mesorectal excision (taTME). Colorectal Dis 20(1):O1\u2013O6","journal-title":"Colorectal Dis"},{"issue":"3","key":"2094_CR23","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1007\/s00464-017-5817-1","volume":"32","author":"L Lee","year":"2018","unstructured":"Lee L et al (2018) Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 32(3):1368\u20131376","journal-title":"Surg Endosc"},{"issue":"4","key":"2094_CR24","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s10151-018-1777-2","volume":"22","author":"SK Perdawood","year":"2018","unstructured":"Perdawood SK (2018) A case of local recurrence following transanal total mesorectal excision: a new form of port-site metastasis? Tech Coloproctol 22(4):319\u2013320","journal-title":"Tech Coloproctol"},{"issue":"9695","key":"2094_CR25","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1016\/S0140-6736(09)61116-8","volume":"374","author":"P McCulloch","year":"2009","unstructured":"McCulloch P et al (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374(9695):1105\u20131112","journal-title":"Lancet"},{"issue":"3","key":"2094_CR26","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/bjs.1800820305","volume":"82","author":"SD Wexner","year":"1995","unstructured":"Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82(3):295\u2013298","journal-title":"Br J Surg"},{"issue":"4","key":"2094_CR27","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1097\/SLA.0000000000002653","volume":"269","author":"M Penna","year":"2019","unstructured":"Penna M et al (2019) Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg 269(4):700\u2013711","journal-title":"Ann Surg"},{"issue":"8","key":"2094_CR28","doi-asserted-by":"publisher","first-page":"3210","DOI":"10.1007\/s00464-015-4615-x","volume":"30","author":"CL Deijen","year":"2016","unstructured":"Deijen CL et al (2016) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30(8):3210\u20133215","journal-title":"Surg Endosc"}],"container-title":["Techniques in Coloproctology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-019-02094-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s10151-019-02094-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-019-02094-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T23:38:30Z","timestamp":1602200310000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s10151-019-02094-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":28,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019,9]]}},"alternative-id":["2094"],"URL":"https:\/\/doi.org\/10.1007\/s10151-019-02094-8","relation":{},"ISSN":["1123-6337","1128-045X"],"issn-type":[{"value":"1123-6337","type":"print"},{"value":"1128-045X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]},"assertion":[{"value":"9 June 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the Ethics Committees of the participating centers. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was not required for this type of study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}