Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 127 consecutive patients from a single Japanese institution

Abstract

Purpose In laparoscopic sphincter-preserving surgery (lap-SPS) for rectal cancer (RC), total mesorectal excision (TME) in low RC patients is difficult. This study aimed to evaluate the short- and long-term outcomes of transanal down-to-up dissection of the distal rectum to achieve TME in lap-SPS for RC near the anus. Methods A total of 137 consecutive patients with RC near the anus underwent lap-SPS, with either transanal rectal dissection under direct vision (TARD), which mobilized the most difficult portion of TME via the anus, or trans-anal TME (TaTME), which used an endoscopic system, between January 2006 and February 2021. Results A total of 127 consecutive patients (87 men), with a median age of 66 years (range: 33–86 years), were included. TARD and TaTME were performed in 51 (40.2%) and 76 (59.8%) patients, respectively. Preoperative treatment was performed in 41 (32.3%) patients. Although operative time in the transanal portion in the TaTME group was longer (p < 0.001), total operative time was unaffected. Median blood loss was lower in the TaTME group (p < 0.001). Postoperative complications developed in 56 (44.1%) patients. TME quality was good for almost all the patients and recurrence occurred in 18 patients (14.2%). The five-year overall survival and disease-free survival rates in the 127 patients were 90.4% and 83.2%, respectively. Conclusion Our data suggest that a transanal down-to-up dissection of the distal rectum might be a viable approach in lap-SPS for RC near the anus. Further studies are needed to examine the differences between TARD and TaTME.