Transanal Total Mesorectal Excision for Treatment of Carcinoma in the Middle or Lower Third Rectum: the Technical Feasibility of the Procedure, Pathological Results, and Clinical Outcome

Abstract

We are trying to illustrate operative, short-term, and pathological outcomes of transanal total mesorectal excision (TaTME) as a surgical procedure for patients who are suffering cancer in the lower or middle rectum. This study included 25 consecutive patients who underwent TaTME for the mid and low cancer rectum. The primary outcome measures included frequency of postoperative (PO) bleeding, leakage, ileus, days to regain bowel function, days for Foley's removal, and erectile function. The secondary outcome measures included operation time, status of resection margins, number, the quality of TME, and duration PO hospital stay. No recorded intraoperative complications. The mean hospital stay was 6.9 ± 2.6 days. The mean duration need for urinary catheter removal and flatus passage were 2.4 ± 2.1 and 1.5 + 0.9 days, respectively. The mean IPSS was returned to normal 12 months after surgery. The mean distal margin distance was 1.9 ± 1.1. Circumferential margin distance was > 1 mm in 23 (92%) patients. The mesorectum was complete in 22 (88%) patients. The survival rate was 88% over 3 years. TaTME could be considered as a safe, feasible, and effective surgical modality for patients who had mid and lower rectal tumors with an excellent pathological outcome.

Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision for Rectal Cancer: A Systematic Review

“…2). 18–20 As a result, 29 studies 11,21–48 totaling 2906 patients were included for quantitative synthesis of data. Included studies are described in Table 1.…”

“…One study only was a randomized controlled trial, 30 8 studies were prospective observational, 11,23,33,38,39,43,44,48 and the remaining 20 were retrospective observational design studies. 21–29,31,32,34–37,40–42,45–47 Eighteen of the included 29 studies were published before the year 2020, 21–26,29–31,33–39,42,47 and 11 were published in 2020. 11,27,28,32,40,41,43–46,48 Eight were multicenter 11,23,28,31,32,41,43,45 (2 of which were international 28,41 ) and 21 were single-center studies.…”

“…Adults from 16 countries (Belgium, China, Denmark, Egypt, France, India, Italy, Korea, Netherlands, Norway, Singapore, Spain, Taiwan, United Kingdom, United States, and Vietnam) were enrolled in the 29 included studies. 11,21–48 Stratification of countries by the number of patients enrolled is illustrated in Supplement 2 http://links.lww.com/DCR/B572. Baseline characteristics of the study populations are summarized in Table 2.…”

“…Baseline characteristics of the study populations are summarized in Table 2. Mean/median age of enrolled patients varied between 53.6 years 21 and 69 years. 43 The proportion of male patients was heterogeneous and varied from 37.5% 26 to 80%.…”

Automatic purse-string suture skill assessment in transanal total mesorectal excision using deep learning-based video analysis

“…Since its introduction in 2010 2 , numerous data have shown safe oncological dissection after TaTME, including margin status and specimen quality 3–5 . Although good short-to-intermediate-term oncological outcomes after TaTME have been reported 6–8 , concerns exist regarding the rate of high local recurrence. In particular, local recurrence with an unconventional multifocal pattern and early occurrence have been reported 9 , 10 , raising serious concerns regarding the procedure in Norway 11 .…”