Technologies, technical steps, and early postoperative results of transanal TME

• Published in: Minimally invasive therapy and allied technologies 2016-09, Vol.25 (5), p.247-256
• Main Authors: Hüscher, Cristiano G. S., Tierno, Simone Maria, Romeo, Valentina, Lirici, Marco Maria
• Format: Article
• Language: English
• Subjects: access platforms for TaTME; Adult; Aged; Aged, 80 and over; dissection technology; Female; Humans; Laparoscopy - methods; Male; Middle Aged; Perioperative Care - methods; Postoperative Complications - epidemiology; Prospective Studies; Quality of Health Care; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; total mesorectal excision; Transanal Endoscopic Surgery - methods; transanal minimally invasive surgery; transanal total mesorectal excision; Treatment Outcome
• ISSN: 1364-5706; 1365-2931
• DOI: 10.1080/13645706.2016.1206024

Introduction: First described in 1982, TME overcomes most of the concerns regarding adequate local control after anterior rectal resection. TME requires close sharp dissection along the so-called Heald's plane down to the levators, with distal dissection often cumbersome. In recent years, Transanal TME was introduced with the aim to improve distal rectal dissection and quality of mesorectal excision. Material and methods: A prospective, non-randomized study, started in 2013, is currently ongoing in two Italian Centers. Study objectives were assessing the safety of TaTME and TME quality. TaTME technique and technologies as performed in these centers and cumulative results at ≤30 postoperative days of the first 102 patients are reported. Results: Early postoperative morbidity and mortality rates were 33.3% (34 pts, 16 Clavien-Dindo I + II and 18 Clavien-Dindo III + IV + V), and 1.96% (two deaths), respectively. The quality of mesorectal excision according to Quirke was: complete in 97.1% and nearly complete in 2.9% of the cases. Conclusions: The results confirm the effectiveness of TaTME, especially regarding the quality of the mesorectal dissection. Open questions regarding standardization, anatomical landmarks, indications, morbidity (with special regard to local infection and sepsis), learning curve and oncological outcomes require further answers from larger studies and RCTs before definitive validation of this procedure.