Learning Curve for Transanal Total Mesorectal Excision for Low Rectal Malignancy

Area of Science:

• Colorectal surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Transanal total mesorectal excision (TaTME) is a key surgical approach for low rectal cancer.
• TaTME is technically demanding, with an undefined learning curve for surgical proficiency.
• Determining the number of cases needed for TaTME mastery is crucial for training and patient outcomes.

Purpose of the Study:

• To assess the learning curve for transanal total mesorectal excision (TaTME).
• To identify the number of cases required for a surgeon to achieve proficiency in TaTME.
• To correlate surgical proficiency with operative time and patient safety outcomes.

Main Methods:

• Retrospective analysis of 128 patients undergoing TaTME.
• Utilized the cumulative sum (CUSUM) method to analyze the learning curve.
• Defined total mesorectal excision completion time as the primary metric for proficiency.

Main Results:

• The TaTME learning curve was divided into three phases: learning (1-38 cases), consolidation (39-70 cases), and maturing (71-128 cases).
• Significant decreases in operative time and total mesorectal excision completion time were observed across the phases.
• Intraoperative adverse events decreased through the phases, with none occurring in the maturing phase. Local recurrence was minimal (1 case in phase III).

Conclusions:

• Surgeons achieve mastery in TaTME after approximately 70 cases, as indicated by total mesorectal excision completion time.
• Post-mastery, TaTME procedures showed no intraoperative adverse events.
• The study demonstrates that oncological safety can be maintained throughout the TaTME learning process.