Short- and long-term impact of the TaTME learning process: a single institutional study

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Transanal total mesorectal excision (TaTME) is an innovative approach for lower rectal cancer.
• TaTME demands advanced technical proficiency, influencing patient outcomes during the learning phase.
• This study investigates the learning curve and its impact on oncologic results.

Purpose of the Study:

• To determine the learning curve for transanal total mesorectal excision (TaTME).
• To assess the influence of the TaTME learning process on 5-year oncologic outcomes.
• To identify key parameters for evaluating TaTME proficiency.

Main Methods:

• A 54-month study of 94 patients undergoing TaTME by experienced surgeons.
• A composite success criterion included conversion rate, procedure completion, morbidity, mesorectal integrity, and margins.
• Moving average and cumulative sum analyses were used to assess the learning curve.

Main Results:

• Operative time decreased throughout the study.
• Success rates stabilized around 14 patients for both surgeons.
• Mesorectal completeness was the most sensitive learning marker (42.9% vs 71.25%; p=0.06).
• The learning curve did not significantly impact morbidity, conversion rates, or R0 resection.
• Five-year oncologic outcomes were comparable across patient groups.

Conclusions:

• The TaTME learning process affects oncologic resection quality but not postoperative morbidity.
• Developing surgical anatomy command and technical skills is crucial.
• Specific educational sessions are necessary to address TaTME challenges.
• Results can inform training programs and prerequisites for future trials.