Laparoscopic transanal total mesorectal excision (taTME) for rectal cancer

Abstract

Background: Total mesorectal excision (TME) and multimodal approach have incredibly changed the long-term outcomes of the patients with mid-low rectal cancer. Open or laparoscopic transabdominal TME represents the gold-standard approach to rectal cancer. However, up-to-down TME is technically demanding, especially in male patients with narrow pelvis, in obese patients. The transanal total mesorectal excision (taTME) seems to exceed the limits of the laparoscopic TME. Methods: After a training made of courses, cadaver-labs, and proctored cases, we approached transanally patients with mild-low rectal cancer. Between 2015 and 2020, 33 patients with rectal cancer have undergone laparoscopic taTME procedure with a single-team approach. Aim of the present paper is to report our initial experience in term of short terms outcomes and histological results. Results: Thirty-three patients with rectal cancer were included in this study: 19 males (57.6%) and 14 females (42.4%). The median distance of the rectal cancer from anal verge was 6.5 cm. Overall, 23 patients (69.7%) underwent long-course neoadjuvant therapy. The overall morbidity rate was 36% (12 patients). Anastomotic leak occurred in two patients (6.2%) that required reoperation. Postoperative mortality was 3%. Specimen was graded as complete in 100% of patients. Circumferential resection margin (CRM) was in median 6.52 mm (range 4–18 mm). Conclusion: The taTME is a safe alternative to standard laparoscopic TME in selected patients with low rectal cancer. This technique which would seem to be feasible if performed by an experienced colorectal surgeon even if practiced in a suburban hospital.