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Peer-reviewedCC BYAnnals of gastroenterological surgery

Local Recurrence and Oncological Outcomes After Transanal Total Mesorectal Excision With Intersphincteric Resection for Lower Rectal Cancer: A Nationwide Multicenter Cohort Study (Ta‐Ta‐Mi Study)

  • Kan Tanabe1
  • Shinichiro Mori1
  • Kenji Baba1
  • Takeru Matsuda2
  • Ichiro Takemasa3
  • Koji Okabayashi4
  • Chikayoshi Tani5
  • Tatsuya Manabe6
  • Yoshihiro Kakeji2
  • Takao Ohtsuka1
  • Seiichiro Yamamoto7
  • Takeshi Naitoh8
1 more authors
  • Ta‐Ta‐Mi Study Group Collaborative of the Japan Society of Laparoscopic Colorectal Surgery
8 affiliations
  1. 1Department of Digestive Surgery Kagoshima University Graduate School of Medical Sciences Kagoshima Kagoshima Japan
  2. 2Division of Gastrointestinal Surgery, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
  3. 3Gastroenterological Surgery Osaka International Medical & Science Center Osaka Japan
  4. 4Department of Surgery Keio University School of Medicine Tokyo Japan
  5. 5Division of Gastrointestinal Surgery, Department of Surgery Asahikawa Medical University Asahikawa Japan
  6. 6Department of Surgery, Faculty of Medicine Saga University Saga Japan
  7. 7Department of Gastroenterological Surgery Tokai University School of Medicine Isehara Japan
  8. 8Department of Lower Gastrointestinal Surgery Kitasato University School of Medicine Sagamihara Japan
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Abstract

Aim: Transanal total mesorectal excision (TaTME) combined with intersphincteric resection (ISR) has emerged as a sphincter‐preserving surgical option for very low rectal cancer. However, multicenter data evaluating oncological outcomes and risk factors for local recurrence (LR) following TaTME with ISR remain limited. This study aimed to evaluate oncological outcomes and identify risk factors for LR in patients undergoing TaTME with ISR.

Methods: This multicenter retrospective cohort study included patients who underwent TaTME with ISR for lower rectal cancer at 26 institutions participating in the Japan Society for Laparoscopic Colorectal Surgery. Oncological outcomes and clinicopathological factors associated with LR were analyzed. Multivariable analysis was performed to identify independent risk factors for LR.

Results: A total of 224 patients were included. The 3‐year LR, recurrence‐free survival (RFS), and overall survival (OS) rates were 7.3%, 79.5%, and 98.1%, respectively. Multivariable analysis identified circumferential resection margin (CRM)/radial margin (RM) positivity as the key independent risk factor for LR. In contrast, pathological features, including histopathological classification, lymphatic invasion, vascular invasion, perineural invasion, and tumor budding, reflected tumor biological aggressiveness rather than surgical performance. A biological aggressiveness score demonstrated a stepwise increase in LR risk according to the number of adverse pathological factors.

Conclusion: TaTME combined with ISR is a feasible sphincter‐preserving option for lower rectal cancer, with acceptable oncological outcomes in a nationwide multicenter cohort. Both surgical factors, particularly margin status, and tumor biological characteristics may contribute to LR risk. Careful margin assessment and close postoperative surveillance are essential for optimizing oncological outcomes.

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Cite

BibTeXRIS
BibTeX
@article{tanabe2026local,
  title = {{Local Recurrence and Oncological Outcomes After Transanal Total Mesorectal Excision With Intersphincteric Resection for Lower Rectal Cancer: A Nationwide Multicenter Cohort Study (Ta‐Ta‐Mi Study)}},
  author = {Kan Tanabe and Shinichiro Mori and Kenji Baba and Takeru Matsuda and Ichiro Takemasa and Koji Okabayashi and Chikayoshi Tani and Tatsuya Manabe and Yoshihiro Kakeji and Takao Ohtsuka and Seiichiro Yamamoto and Takeshi Naitoh and Ta‐Ta‐Mi Study Group Collaborative of the Japan Society of Laparoscopic Colorectal Surgery},
  journal = {Annals of gastroenterological surgery},
  year = {2026},
  month = oct,
  doi = {10.1002/ags3.70304},
  url = {https://europepmc.org/article/PMC/PMC13722975},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Local Recurrence and Oncological Outcomes After Transanal Total Mesorectal Excision With Intersphincteric Resection for Lower Rectal Cancer: A Nationwide Multicenter Cohort Study (Ta‐Ta‐Mi Study)
AU  - Kan Tanabe
AU  - Shinichiro Mori
AU  - Kenji Baba
AU  - Takeru Matsuda
AU  - Ichiro Takemasa
AU  - Koji Okabayashi
AU  - Chikayoshi Tani
AU  - Tatsuya Manabe
AU  - Yoshihiro Kakeji
AU  - Takao Ohtsuka
AU  - Seiichiro Yamamoto
AU  - Takeshi Naitoh
AU  - Ta‐Ta‐Mi Study Group Collaborative of the Japan Society of Laparoscopic Colorectal Surgery
PY  - 2026
DA  - 2026/10/31
JO  - Annals of gastroenterological surgery
DO  - 10.1002/ags3.70304
UR  - https://europepmc.org/article/PMC/PMC13722975
AB  - Aim: Transanal total mesorectal excision (TaTME) combined with intersphincteric resection (ISR) has emerged as a sphincter‐preserving surgical option for very low rectal cancer. However, multicenter data evaluating oncological outcomes and risk factors for local recurrence (LR) following TaTME with ISR remain limited. This study aimed to evaluate oncological outcomes and identify risk factors for LR in patients undergoing TaTME with ISR.  Methods: This multicenter retrospective cohort study included patients who underwent TaTME with ISR for lower rectal cancer at 26 institutions participating in the Japan Society for Laparoscopic Colorectal Surgery. Oncological outcomes and clinicopathological factors associated with LR were analyzed. Multivariable analysis was performed to identify independent risk factors for LR.  Results: A total of 224 patients were included. The 3‐year LR, recurrence‐free survival (RFS), and overall survival (OS) rates were 7.3%, 79.5%, and 98.1%, respectively. Multivariable analysis identified circumferential resection margin (CRM)/radial margin (RM) positivity as the key independent risk factor for LR. In contrast, pathological features, including histopathological classification, lymphatic invasion, vascular invasion, perineural invasion, and tumor budding, reflected tumor biological aggressiveness rather than surgical performance. A biological aggressiveness score demonstrated a stepwise increase in LR risk according to the number of adverse pathological factors.  Conclusion: TaTME combined with ISR is a feasible sphincter‐preserving option for lower rectal cancer, with acceptable oncological outcomes in a nationwide multicenter cohort. Both surgical factors, particularly margin status, and tumor biological characteristics may contribute to LR risk. Careful margin assessment and close postoperative surveillance are essential for optimizing oncological outcomes.
SN  - 2475-0328
ER  -