Total mesorectal excision (TME) represents the key principle in the surgical treatment of rectal cancer. Transanal mesorectal excision was introduced as a complement to conventional surgery to overcome its technical difficulties. The aim of this study was to evaluate the early surgical results following the introduction of this novel technique at our Unit. Between January and May 2016, 12 patients diagnosed with mid-low rectal adenocarcinoma were enrolled into this study and evaluated with regards demography, histopathology, peri-operative data and postoperative complications. The tumor was located in the middle rectum in 6 patients (50%), in the lower rectum in 6 patients (50%). Mean operative time was 356.5 ± 76.2 min (range 240–494). Eleven out 12 patients (91.6%) had less than 200 mL of intraoperative blood loss. Mean hospital stay was 10.9 ± 4.6 days (range 5–19). No mortality was recorded. Intraoperative complications were recorded in 1, while early post-operative complications (< 30 days) were observed in 5 patients (41.6%). Histopathology showed in all cases an intact mesorectum. Mean number of lymphnodes harvested was 13.6 ± 6.6 (range 4–29). Distal and circumferential margin was, respectively, of 20.8 ± 14.2 mm (range 2–45 mm) and 16.1 ± 7.6 mm (range 3–30 mm). The comparative analysis showed significant differences concerning mean operative time (p = 0.0473) and estimated blood loss (p = 0.0367). This study confirms this technique is safe and feasible, but more evidence to support its use over conventional laparoscopic surgery is needed.
TME Transanal surgery Rectal cancer Laparoscopy
This is a preview of subscription content, log in to check access.
The authors would like to thank Mr Tan Arulampalam for his precious help with English editing and proofreading.
Compliance with ethical standards
Conflict of interest
Drs. Michele De Rosa, Fabio Rondelli, Marcello Boni, Fabio Ermili, Walter Bugiantella, Lorenzo Mariani, Graziano Ceccarelli and Antonio Giuliani have no conflicts of interest or financial ties to disclose.
All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefGoogle Scholar
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 327:1479–1482CrossRefGoogle Scholar
Nagtegaal ID, van de Velde CJ, van der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734CrossRefGoogle Scholar
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
Rattner D, Kalloo A; ASGE/SAGES Working Group (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 20:329–333Google Scholar
Sylla P, Rattner DW, Delgado S et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210CrossRefGoogle Scholar
Maslekar S, Sharma A, Macdonald A et al (2007) Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum 50:168–175CrossRefGoogle Scholar
Kang SB, Park JS, Kim DW et al (2010) Intraoperative technical difficulty during laparoscopy-assisted surgery as a prognostic f actor for colorectal cancer. Dis Colon Rectum 53:1400–1408CrossRefGoogle Scholar
Akiyoshi T, Kuroyanagi H, Oya M et al (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489CrossRefGoogle Scholar
Brannigan AE, De Buck S, Suetens P et al (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge. Surg Endosc 20:952–955CrossRefGoogle Scholar
Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137CrossRefGoogle Scholar
Veltcamp Helbach M, Deijen CL, Velthuis S et al (2016) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 30:464–470CrossRefGoogle Scholar
Tuech JJ, Karoui M, Lelong B et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261:228–233CrossRefGoogle Scholar
Rouanet P, Mourregot A, Azar CC et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415CrossRefGoogle Scholar
Cecil TD, Sexton R, Moran BJ et al (2004) Total mesorectal excision results in low local recurrence rates in lymph node positive rectal cancer. Dis Colon Rectum 47:1145–1149 (discussion 1149–1150)Google Scholar
Arezzo A, Passera R, Scozzari G et al (2013) Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and metaanalysis. Surg Endosc 27:1485–1502CrossRefGoogle Scholar
Lujan J, Valero G, Hernàndez Q et al (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989CrossRefGoogle Scholar
Strohlein MA, Grutzner KU, Jauch KW et al (2008) Comparison of laparoscopic vs. open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 51:385–391Google Scholar
Lelong B, Bege T, Esterni B et al (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 50:176–183CrossRefGoogle Scholar
Faerden AE, Naimy N, Wiik P et al (2005) Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer. Dis Colon Rectum 48:2224–2231CrossRefGoogle Scholar
Staudacher C, Vignali A, Saverio D et al (2007) Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer: Impact on early outcome. Dis Colon Rectum 50:1324–31Google Scholar
Elmore U, Fumagalli RU, Vignali A et al (2015) Laparoscopic anterior resection with transanal total mesorectal excision for rectal cancer: preliminary experience and impact on postoperative bowel function. J Laparoendosc Adv Surg Tech A 25:364–369CrossRefGoogle Scholar
Kneist W, Wachter N, Paschold M et al (2016) Midterm functional results of taTME with neuromapping for low rectal cancer. Tech Coloproctol 20:41–49CrossRefGoogle Scholar
Ma B, Gao P, Song Y et al (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380Google Scholar
Xu W, Xu Z, Cheng H et al (2016) Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: a meta-analysis. Eur J Surg Oncol 42:1841–1850CrossRefGoogle Scholar