Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME

Abstract

BackgroundTransanal total mesorectal excision (TaTME) is emerging as a novel alternative to laparoscopic total mesorectal excision (LaTME). The aim of this study was to compare clinical and pathological results from these two techniques in patients undergoing rectal resections because of low rectal cancer.Materials and methodsThirty-five patients undergoing TaTME were matched with 35 patients operated on using LaTME. Composite primary endpoint (complete TME, negative circumferential resection margin [pCRM], and distal resection margin [pDRM]) was used to assess pathological quality specimens. Secondary outcomes included operative and postoperative parameters (operative time, total blood loss, postoperative morbidity, length of stay, 30-day mortality).ResultsComposite primary endpoint was achieved by 85% of subjects in the TaTME group and 82% of subjects in the LaTME group (P=0.66). Mean pCRM was 1.1±1.29 vs 0.99±0.78 mm (P=0.25). Distal pDRM was 1.57±0.92 and 1.98±1.22 cm (P=0.15). In the TaTME and LaTME groups, respectively, complete mesorectal excision was achieved in 89% and 83% of subjects, while excision was nearly complete for the remaining 11% and 17% (P=0.23).ConclusionTaTME appears to be a noninferior alternative to laparoscopic surgery. TaTME allows for quality retrieval of surgical specimens with comparable clinical outcomes with LaTME.

Transanal total mesorectal excision for rectal cancer has been suspended in Norway

“…), and that more than one‐third of all patients still had a stoma at the end of the study. One of the presumed advantages of TaTME is a reduced need for permanent stomas, but the findings in this national cohort do not support the method as a means of avoiding a stoma.…”

“…The transanal approach aims to increase visibility and give better access to the dissection planes, and thus to increase the quality of the resected specimen. TaTME should also offer a safer anastomotic technique by the use of a distal purse‐string suture, allowing a low anastomosis in patients who might otherwise need a permanent stoma. The indication for TaTME has currently been extended to include higher tumours and women.…”

“…The indication for TaTME has currently been extended to include higher tumours and women. The oncological results after TaTME have been evaluated in terms of risk factors such as CRM and completeness of mesorectal fascia.…”

“…Assessments of complication rates, duration of surgery and length of hospital stay have led to the conclusion that TaTME is safe. TaTME has, however, been met with some concerns, as the evidence seems to be hampered by scientific spin.…”

Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer: a meta-analysis of short-term outcomes

“…One thousand two hundred and forty-seven citations were retrieved from the search strategy. Finally, twelve studies [24][25][26][27][28][29][30][31][32][33][34][35] were included in the analysis, with a total of 899 patients (411 patients in TaTME group, 488 patients in LaTME group) ( Figure 1). The characteristics of eligible studies are shown in Table I.…”