[Present conditions and problems of transanal total mesorectal excision in rectal cancer]

Transanal total mesorectal excision (taTME) is a very innovative approach for the treatment of rectal cancer. This technique comes from some concepts such as natural-orifice transluminal endoscopic surgery (NOTES), transanal endoscopic microsurgery(TEM), transanal transabdominal operation(TATA), transanal minimally invasive surgery(TAMIS) and total mesorectum excision (TME). It has emerged in a dozen countries throughout the world in recent years. We have performed taTME in patients after a series of animal and human cadaver operations, and the technique approved by Ethics committee of the Six Affiliated Hospital of Sun Yat-sen University. The initial results seem to be advantageous in terms of distal margin and circumferential margins especially in obese and narrow pelvis, minimally invasiveness, reduced complications of anastomosis. There are no results on the long term functional and oncological outcomes by multiple center RCT clinical trials with taTME until now. This novel approach must be governed by skills acquisition and mentorship; it could become a valid alternative for patients with middle and low rectal cancer after experience accumulation and optimized operation equipment.