Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Laparoscopic total mesorectal excision (LaTME) is a standard for rectal cancer but can be challenging in the distal rectum.
• Difficulties in low rectal LaTME may lead to complications and suboptimal oncological outcomes.
• Transanal TME (TaTME) presents a potential solution to overcome these challenges.

Purpose of the Study:

• To compare the short-term outcomes of transanal TME (TaTME) with laparoscopic TME (LaTME).
• To evaluate radical resection rates, specimen quality, and postoperative complications.
• To assess operative time and hospital stay for both surgical approaches.

Main Methods:

• A prospective database of 25 TaTME patients was compared to 25 historical LaTME patients.
• Inclusion criteria comprised low anterior resection or intersphincteric abdominoperineal excision.
• Primary endpoints included radical resection and specimen quality; secondary endpoints covered complications, conversion rates, operating time, and hospital stay.

Main Results:

• TaTME showed a trend towards better circumferential resection margins (1 positive vs 4 positive).
• Specimen quality was complete or nearly complete in all TaTME cases versus 21/25 in LaTME.
• TaTME resulted in significantly less blood loss, shorter operating time, and shorter hospital stay compared to LaTME.

Conclusions:

• Transanal TME (TaTME) demonstrates comparable pathological results to LaTME.
• Short-term postoperative outcomes for TaTME are acceptable and potentially improved.
• TaTME may offer advantages in operative efficiency and patient recovery for rectal cancer surgery.