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Transanal total mesorectal excision: Towards standardization of technique
Albert M Wolthuis1, Gabriele Bislenghi1, Anthony de Buck van Overstraeten1
1Albert M Wolthuis, Gabriele Bislenghi, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, 3000 Leuven, Belgium.
Aim:
To describe the role of Transanal total mesorectal excision (TaTME) in minimally invasive rectal cancer surgery, to examine the differences in patient selection and in reported surgical techniques and their impacts on postoperative outcomes and to discuss the future of TaTME.
Methods:
MEDLINE (PubMed), EMBASE, and The Cochrane Library were systematically searched through the 1(st) of March 2015 using a predefined search strategy.
Results:
A total of 20 studies with 323 patients were included. Most studies were single-arm prospective studies with fewer than 100 patients. Multiple transanal access platforms were used, and the laparoscopic approach was either multi- or single port. The procedure was initiated transanally or transabdominally. If a simultaneous approach with 2 operating surgeons was chosen, the operative time was significantly reduced.
Conclusion:
TaTME was also associated with better TME specimens and a longer distal resection margin. TaTME is thus feasible in expert hands, but the learning curve and safety profile are not well defined. Long-term follow-up regarding anal function and oncological outcomes should be performed in the future.
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