Transanal total mesorectal excision (TaTME): current status and future perspectives

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Total mesorectal excision (TME) is standard for mid/low rectal cancer but presents technical challenges.
• Transanal TME (TaTME) was developed to enhance visualization and overcome TME's surgical difficulties.
• TaTME aims for more accurate dissections and improved sphincter preservation rates.

Purpose of the Study:

• To critically analyze the benefits and risks of Transanal TME (TaTME).
• To review current indications, short- and long-term outcomes, and future directions for TaTME.
• To compare TaTME with conventional open or laparoscopic TME.

Main Methods:

• Review of existing literature on Transanal TME (TaTME).
• Analysis of safety, feasibility, and oncologic outcomes of TaTME.
• Comparison of TaTME with traditional TME approaches.

Main Results:

• TaTME is feasible and safe, with comparable complication and readmission rates to conventional TME.
• Favorable short-term oncologic results reported, including better specimen quality and longer distal margins.
• Enhanced visualization in TaTME facilitates accurate distal dissection under direct view.

Conclusions:

• TaTME is a promising technique for rectal cancer surgery, offering potential advantages in visualization and oncologic outcomes.
• Ongoing training and robotics may mitigate the learning curve associated with TaTME.
• Further long-term data from RCTs are needed to fully evaluate functional results, recurrence, and survival rates.