Transanal total mesorectal excision for patients with middle-low rectal cancer in locally advanced stage

Abstract

Introduction: Patients with middle-low rectal cancer in advanced stage had many difficulties in performing laparoscopic total mesorectal excision (TME), especially in those with narrow pelvis or obese with or without neoadjuvant therapy. We conducted the study of transanal TME (TaTME) for these patients to evaluate the safety and efficacity of this technique. Material and Methods: Prospective study. Patients with middle-low rectal cancer in advanced stage underwent rectal resection with TaTME technique were enrolled. Results: 38 patients including 25 middle and 13 low rectal tumors underwent elective rectal resection by TaTME from March 2015 to September 2018. Male/female ratio: 25/13. Mean age: 58.2 ± 16.4 and BMI: 24.2 ±2.5 kg/m2. Mean operation duration:210 ± 42 minutes. Specimen were removed through abdominal incision in 23 patients and 15 via anus. Anastomoses were performed by hands in 100% patients. The protective ileostomie was performed 100%. One left ureteral burning and postoperative difficulty in voiding, one presacral abscess due to anastomotic fistula and one totally leakage of the anastomose. Good Quirke assessment in 87% patients. The distal resection margins (DRM) was 20 ± 5 mm. Distal resection margins (DRM) were negative in 100% patients and circumferential resection margins (CRM) were positive in one (2.6%) patients. The hospital stay was 6 days. Median follow-up time was 12 months. One patient had local recurrence at 18th months and 1 had liver metastasis at 6th months. Conclusion: TaTME for patients with middle-low rectal cancer in advanced stage is safe and efficacious. However, there is a need for large, multicentric studies to accurately evaluate this technique.