Transanal total mesorectal excision: how are we doing so far?

Abstract

AimThis subgroup analysis of a prospective multicentre cohort study aims to compare postoperative morbidity between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME).MethodThe study was designed as a subgroup analysis of a prospective multicentre cohort study. Patients undergoing TaTME or LaTME for rectal cancer were selected. All patients were followed up until the first visit to the outpatient clinic after hospital discharge. Postoperative complications were classified according to the Clavien–Dindo classification and the comprehensive complication index (CCI). Propensity score matching was performed.ResultsIn total, 220 patients were selected from the overall prospective multicentre cohort study. After propensity score matching, 48 patients from each group were compared. The median tumour height for TaTME was 10.0 cm (6.0–10.8) and for LaTME was 9.5 cm (7.0–12.0) (P = 0.459). The duration of surgery and anaesthesia were both significantly longer for TaTME (221 vs 180 min, P < 0.001, and 264 vs 217 min, P < 0.001). TaTME was not converted to laparotomy whilst surgery in five patients undergoing LaTME was converted to laparotomy (0.0% vs 10.4%, P = 0.056). No statistically significant differences were observed for Clavien–Dindo classification, CCI, readmissions, reoperations and mortality.ConclusionThe study showed that TaTME is a safe and feasible approach for rectal cancer resection. This new technique obtained similar postoperative morbidity to LaTME.

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

“…The TaTME anastomotic technique in the present study resulted in a higher leakage rate than in non‐TaTME operations (NoRGast data). The rates of anastomotic failure, such as leaks, pelvic abscesses, anastomotic fistulas and strictures, as well as chronic sinuses, have been reported to be as high as 15·7 per cent after TaTME among 1954 patients in one study and 20 per cent among 48 patients in another. The leak rates most likely reflect a difficult surgical procedure, and the present study does not support the statement that TaTME provides an acceptably safe anastomosis.…”

“…It is also of concern that TaTME might lead to an unnecessarily low anastomosis in most patients, as tumours in the present study were located between 5 and 13 cm from the anal verge. Reports of hitherto infrequent serious urethral injuries, which also occurred in the present cohort, indicate the difficulties inherent in dissection from below, as does the number of rectal perforations.…”

Meta-analysis of transanal versus laparoscopic total mesorectal excision for rectal cancer: a ‘New Health Technology’ assessment in South Korea

“…Finally, 16 cohort studies met all the inclusion criteria and none of the exclusion criteria ( Fig. 1 ) [ 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ]. Seven of the cohort studies were case-matched studies comparing TaTME with LaTME for rectal cancer [ 25 28 29 30 31 36 38 ].…”

“…1 ) [ 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ]. Seven of the cohort studies were case-matched studies comparing TaTME with LaTME for rectal cancer [ 25 28 29 30 31 36 38 ]. The patient demographics, clinical characteristics, and quality assessment scores are shown in Table 1 and Supplementary Table 1 .…”

The value of force and torque measurements in transanal total mesorectal excision (TaTME)

“…Especially if the tumor is located in the low rectum, sphincter preservation procedures pose relatively high risks of leaving a positive circumferential resection margin (CRM) [11]. Due to these difficulties, following laparoscopic transanal minimally invasive surgery (TAMIS), the transanal TME (TaTME) technique has received tremendous attention all over the world and is being implemented at high speed [6,[12][13][14]. However, concerns exist about the learning curve and therefore, patient safety [15,16].…”