[Controversy and prospect of transanal total mesorectal excision]

Area of Science:

• Colorectal Surgery
• Minimally Invasive Procedures
• Oncologic Surgery

Background:

• Transanal total mesorectal excision (taTME) is an emerging surgical technique for rectal cancer.
• Despite rapid development, taTME faces skepticism regarding its safety, efficacy, and indications.
• Concerns include surgical complications, specimen quality, recurrence rates, and functional outcomes.

Purpose of the Study:

• To critically evaluate the current controversies surrounding taTME.
• To assess the safety and effectiveness of taTME in clinical practice.
• To provide recommendations for the future development of taTME in China.

Main Methods:

• Review of existing literature on taTME.
• Analysis of reported surgical complications and outcomes.
• Discussion of controversies regarding case selection, procedures, and cost-effectiveness.

Main Results:

• Reported complications include urethral injury, CO2 embolism, anastomotic leakage, and pelvic infection.
• Concerns exist regarding specimen quality, local recurrence rates, and impaired anal function.
• taTME shows promise as a supplementary procedure, particularly for low rectal cancer.

Conclusions:

• taTME presents a promising future in rectal cancer surgery.
• It is considered a relatively safe and effective supplementary technique for low rectal cancer.
• Standardization requires structured training for surgeons and high-quality clinical studies to generate robust evidence.