Transanal Total Mesorectal Excision for Rectal Cancer: Short Term Outcomes from Two Centers.

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Gastroenterology

Background:

• Rectal cancer incidence is rising globally.
• Transanal resection, with or without laparoscopic assistance, represents a new era in minimally invasive rectal cancer surgery.
• Hybrid NOTES techniques are emerging for rectal cancer treatment.

Purpose of the Study:

• To assess the feasibility of hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) for rectal cancer.
• To document the initial experience with this technique in Egypt and Spain.

Main Methods:

• A prospective study was conducted between September 2015 and November 2017.
• Eighteen patients with rectal cancer underwent transanal total mesorectal excision using a hybrid NOTES approach.
• Outcomes were evaluated based on mortality, morbidity (Clavien-Dindo classification), and quality of resection.

Main Results:

• No mortality was observed in the 18 cases.
• Overall morbidity was 44%, with 5 cases (Clavien-Dindo class III) requiring intervention.
• High-quality total mesorectal excision was achieved in over 75% of patients.

Conclusions:

• The hybrid NOTES technique for rectal cancer is technically demanding and has a steep learning curve.
• Despite challenges, short-term outcomes were very good, aligning with limited existing reports.
• This approach shows promise for selected rectal cancer cases.