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Long Term Functional Outcomes After Transabdominal Versus Transanal Total Mesorectal Excision: A Matched Comparative
Jayson Moloney1,2, Steven Lau3, Fraser Jeffery4
1Department of Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
ANZ Journal of Surgery
|November 21, 2025
Summary
Transanal total mesorectal excision (TaTME) may lead to poorer bowel function, especially faecal incontinence, compared to transabdominal approaches. Further research is needed to optimize TaTME outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Patient Outcomes Research
Background:
- Transanal total mesorectal excision (TaTME) is utilized for low rectal tumors with difficult pelvic access.
- Functional outcomes of TaTME versus transabdominal approaches are not well-established.
Purpose of the Study:
- To compare the functional outcomes of TaTME with the conventional transabdominal total mesorectal excision.
- To evaluate bowel, urinary, and overall function after TaTME.
Main Methods:
- A cohort study comparing TaTME patients (2009-2018) with a matched transabdominal total mesorectal excision cohort from the ALaCaRT trial.
- Patients completed surveys using validated tools: low anterior resection syndrome (LARS), International Prostate Symptom Score (IPSS), and EORTC CR29.
Main Results:
- 100 TaTME patients were enrolled (50% response rate). Major LARS reported in 69.3% of patients.
- TaTME group showed significantly poorer outcomes in faecal incontinence, blood/mucus in stool, and flatulence compared to the transabdominal group.
- No significant differences were found in urinary function between the groups.
Conclusions:
- TaTME may negatively impact functional outcomes, particularly faecal incontinence, compared to transabdominal total mesorectal excision.
- Despite advantages in challenging pelvic access, functional compromises warrant consideration in patient selection and surgical technique.
