Let’s make a rendezvous.

Top Line: A rendezvous procedure is an invasive procedure that combines percutaneous and endoscopic and / or surgical methods to minimize invasiveness.

The Study: For rectal cancer, it comes in the form of a transanal total mesorectal excision (TME). But combining all those skills into one comes with a steep learning curve, and we all know what can happen when getting too fancy with oncologic resections. In fact, Norway and the UK strongly discouraged a transanal approach to TME after noting an associated aberrant rise in multifocal local recurrences. Now the Canadians are giving their two cents in hopes of saving this approach from condemnation to cautionary tales only. Here is a look back at 608 consecutive patients receiving transanal TME for rectal cancer across eight high-volume Canadian centers. Local recurrences occurred in 22 patients (3.6%) at a median of 13 months. Looked at differently, local recurrence-free survival was 96% at 3 years, in line with contemporary standards. Of note, over two-thirds (n=15) of those with local recurrence also had distant recurrence, and virtually all (n=20) came after conversion to open resection. In a step outside the norm of Canadian niceties, the authors fear data from other countries may simply “reflect technical inadequacies of a series of early cases.” In any case, the best answer is yet to come upon completion of ongoing randomized trials.

TBL: In the largest national database to date, high volume centers and surgeons in Canada have achieved excellent oncologic outcomes with minimally-invasive transanal TME for select patients with rectal cancer. | Caycedo-Marulanda, JAMA Netw Open 2021