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Updated: Dec 3, 2025
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional
Roberto Persiani1,2, Annamaria Agnes1,2, Francesco Belia2
1Dipartimento Scienze Mediche e Chirurgiche, UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli n. 8, 00168, Rome, Italy.
Background:
Transanal total mesorectal excision (TaTME) was introduced in 2009 as a dedicated approach for the treatment of mid-low rectal cancer. We aimed to describe and discuss the learning curve for 121 consecutive TaTME procedures performed by the same team.
Methods:
The primary outcome was the number of operations required to decrease the mean operative time (mOT). The secondary outcomes were the number of operations required to decrease the major complication (MC) rate, the anastomotic leakage (AL) rate, the clinical anastomotic failure rate, and the reoperation rate. A cumulative sum (CUSUM) curve analysis was used to identify the inflection points. As an integrative analysis, Bernoulli CUSUM curves, risk-adjusted CUSUM curves based on the observed-expected outcomes, and CUSUM curves targeting results reported in the literature were created.
Results:
Seventy-one cases were needed to overcome the OT learning curve sufficiently to reach mastery. The MC and reoperation rates started to decrease after the 54th case and further decreased after the 69th case. The AL rate started to decrease after the 27th case and remained stable at 5-5.1%. The comparison between the different phases of the learning curves confirmed these turning points.
Conclusions:
TaTME had a learning curve of 71 cases for the mOT, 55-69 cases for MCs and reoperation, and 27 cases for AL. According to our results, attention should be paid during the first part of the learning curve to avoid an increased rate of MCs and AL.
