Impact of Obesity on Postoperative Outcomes in Transanal Total Mesorectal Excision for Rectal Cancer.
Publication Title
Diseases of the colon and rectum
Document Type
Article
Publication Date
12-11-2025
Keywords
Obesity; Rectal adenocarcinoma; Transanal total mesorectal excision.; oregon; portland; ppmc
Abstract
BACKGROUND: Transanal total mesorectal excision (taTME) has been increasingly adopted in the curative resection of low rectal cancer. Obesity is a known risk factor for conversion and morbidity during laparoscopic and robotic TME.
OBJECTIVE: We sought to compare short-term postoperative and pathologic outcomes and long-term oncologic outcomes of transanal total mesorectal excision between non-obese vs. obese patients across high-volume rectal cancer centers in the United States.
DESIGN: Retrospective cohort study.
SETTINGS: Eight tertiary centers in the United States of America.
PATIENTS: Eligible patients underwent transanal total mesorectal excision for curative resection of primary rectal adenocarcinoma between November 2011 and June 2020.
MAIN OUTCOME MEASURES: Intraoperative complications, 30-day postoperative complications, local recurrence, distant recurrence, overall survival, disease-free survival.
RESULTS: A total of 390 transanal total mesorectal excision procedures were performed in 271 (69.5%) non-obese (BMI < 30 kg/m2) and 120 (30.5%) obese (BMI ≥ 30 kg/m2) patients with a median BMI of 27.4 kg/m2 (IQR 24.1-31.0). The median follow-up was 29 months (IQR 14-44 months). There were no significant differences in tumor stage or neoadjuvant treatment across groups. Tumors were located ≤ 6cm from the anal verge in 60.6% of patients. Operative time was longer in the obese group, with no significant differences in conversion rates or intraoperative complications. No significant differences in postoperative complications, including Clavien-Dindo grade ≥3 complications, anastomotic complications or reoperation rates were noted between non-obese and obese cohorts. At a median follow-up of 29 months, local recurrence, overall survival, and disease-free survival were comparable between the groups, while obese patients had a significantly lower rate of distant recurrence than non-obese patients.
LIMITATIONS: Retrospective design, short median follow up time.
CONCLUSIONS: In this multicenter retrospective study, transanal total mesorectal excision resulted in similar conversion and morbidity rates among obese and non-obese patients. Obesity was associated with a significantly lower 3-year distant recurrence with no differences in other mid-term oncologic outcomes.
Area of Special Interest
Digestive Health
Area of Special Interest
Cancer
Specialty/Research Institute
Gastroenterology
Specialty/Research Institute
Oncology
DOI
10.1097/DCR.0000000000004090
