Transanal total mesorectal excision for rectal cancer

Abstract

Although laparoscopic surgery for rectal cancer has been gaining acceptance with the gradual accumulation of evidence, it remains a technically demanding procedure in patients with a narrow pelvis, bulky tumors, or obesity. To overcome the technical difficulties associated with laparoscopic rectal dissection and transection, transanal endoscopic rectal dissection, which is also referred to as transanal (reverse, bottom-up) total mesorectal excision (TME), has recently been introduced. Its potential advantages include the facilitation of the dissection of the anorectum, regardless of the patient body habitus, and a clearly defined safe distal margin and transanal extraction of the specimen. This literature review shows that this approach seems to be feasible with regard to the operative and short-term postoperative outcomes. In experienced hands, transanal TME is a promising method for the resection of mid- and low-rectal cancers. Further investigations are required to clarify the long-term oncological and functional outcomes.

Transanal TME: new standard or fad?

“…Several types of transanal platforms have been used, including rigid type (i.e., TEO) or single-port devices 16) . Currently, the most popular platform is the GelPOINT path transanal access platform (Applied Medical, Ranco Santa Margarita, CA), which allows for better instrumental triangulation in the narrow operative field.…”

Advantages of the transperineal approach for secondary rectal cancer following prior radiotherapy to prostate cancer – a video vignette

“…Considering the anatomical proximity of the rectum to the prostate, the increased fibrosis caused by prior radiotherapy is crucial during anterior dissection of the rectum. Recently, a transanal/transperineal approach for rectal cancer has attracted intense attention as a promising approach .…”

Técnicas quirúrgicas para la preservación de esfínter en cáncer de recto bajo: revisión histórica y estado actual

“…El abordaje transanal con dispositivos e instrumental similar al de la laparoscopia (Figura 1) para la TME, tiene el beneficio teórico de entregar una evaluación directa del margen distal, mejor visualización, y por lo tanto, lograr una mejor calidad del mesorrecto. Fue el mismo R.J. Heald quien la describió como una técnica revolucionaria, sin embargo, la evidencia no ha logrado demostrar un beneficio franco por sobre las otras técnicas 15 . A nivel nacional, las series de casos publicados han demostrado buenos resultados quirúrgicos 16 .…”