Advanced Application of TaTME Platform For a T4 Anterior Rectal Tumor

Abstract

Transanal total mesorectal excision (TaTME) is a rapidly progressing technique in the management of both benign and malignant rectal disease. It is a technical advance to the current gold-standard approach to rectal cancer, the transabdominal total mesorectal excision. Until now, T4 stage cancers have been considered a relative contraindication to TaTME due to the perceived technical difficulty and increased complication rate. This case describes the TaTME operative technique for a T4b locally advanced, mid rectal anterior tumor in a young male postneoadjuvant chemoradiation. Employing a dual team hybrid TaTME (Cecil approach) with laparoscopic abdominal assistance, this case highlights the ability of TaTME to be successfully utilized in more advanced malignancy and technically difficult patients without an increase in complications, operative time, or hospital length of stay.

Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

“…Other authors also include locally-advanced rectal tumors underwent TaTME as we made with optimal pathological and clinical outcomes suggesting experienced surgeons in TaTME could successfully perform it in these cases. [18][19][20][21] Therefore, we do not recommend TaTME in patients with locally-advanced rectal tumors during the learning curve for the TaTME procedure. 22 The rate of postoperative morbidity in the present series was of 32%, and there were no statistically significant differences between the TaTME (35%) and LaTME (30%) groups (p ¼ 0.763).…”

“…Other authors also include locally-advanced rectal tumors underwent TaTME as we made with optimal pathological and clinical outcomes suggesting experienced surgeons in TaTME could successfully perform it in these cases. 18 19 20 21 Therefore, we do not recommend TaTME in patients with locally-advanced rectal tumors during the learning curve for the TaTME procedure. 22…”

Beyond transanal total mesorectal excision: short‐term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision

“…Then a partial prostatectomy or seminal vesicle resection can be performed if required. This is easier than exclusively undertaking a top‐down approach, given that in the setting of a narrow pelvis or bulky tumour, resecting the rectum plus en bloc seminal vesicles or prostate in a controlled manner can be challenging [25].…”

“…Adjuvant therapy and followup data pelvis or bulky tumour, resecting the rectum plus en bloc seminal vesicles or prostate in a controlled manner can be challenging [25].…”

Application of a hybrid robotic and transanal total mesorectal excision approach to resect a bulky low rectal gastrointestinal stromal tumour

“…Robotic resection of upper gastrointestinal GISTs has been described, 1 but there is a paucity of data on the application of this approach to rectal GISTs. In rectal adenocarcinoma, transanal total mesorectal excision (taTME) has been described as having potential technical advantages in the resection of bulky low T4 tumours 2 . This case demonstrates the application of a hybrid robotic and taTME approach to a bulky rectal GIST with intact excision of the tumour.…”