Current Status and Advances in the Clinical Application of Transanal Total Mesorectal Excision for Middle and Lower Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Zhenning ^1,2 , ZOU Min ^1,3 , WANG Dechen ⁴ , YANG Kang ⁴ , GUI Mingbin ^1,4 ,  XU Ming ¹

1. Department of Anorectal Surgery, 940 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730030, China;
2. Department of Anorectal Surgery, Northwest University for Nationalities, Lanzhou 730030, China;
3. Gansu University of Traditional Chinese Medicine, Lanzhou 730030, China;
4. Ningxia Medical University, Yinchuan 750004, China;

Corresponding author：

XU Ming, Email: drxuming@qq.com

Keywords：

Middle and Lower rectal cancer; Transanal total mesorectal excision (TaTME); Operative platform; Laparoscopic total mesorectal excision; Learning curve

DOI：

10.7507/1007-9424.202412044

Video：

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Objective To evaluate the short-term clinical outcomes of transanal total mesorectal excision (TaTME) and provide evidence for clinical decision-making. Methods Relevant literature from domestic and international databases in recent years was reviewed to systematically assess the current application of TaTME in the treatment of mid-to-low rectal cancer. A comparative analysis was conducted between TaTME and laparoscopic TME (LapTME), focusing on intraoperative outcomes, short-term postoperative recovery, intraoperative and postoperative complications, oncological prognosis, and the learning curve. Results Conventional LapTME presents significant challenges in performing precise maneuvers within the pelvis and around the rectum, particularly in patients with "difficult pelvis" characteristics such as obesity, narrow pelvis, or male anatomy. In contrast, TaTME demonstrates certain advantages, including improved visualization of anatomical planes, reduced intraoperative bleeding, lower conversion rates to open surgery, faster short-term postoperative recovery, and enhanced specimen quality. Conclusion TaTME is a safe procedure with short-term outcomes that are superior or comparable to those of laparoscopic surgery, offering a new surgical option for the treatment of low rectal cancer.

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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Butterworth JW, Butterworth WA, Meyer J, et al. A systematic review and meta-analysis of robotic-assisted transabdominal total mesorectal excision and transanal total mesorectal excision: which approach offers optimal short-term outcomes for mid-to-low rectal adenocarcinoma?. Tech Coloproctol, 2021, 25(11): 1183-1198.
3. 李大卫. 腹腔镜辅助的经肛全直肠系膜切除术的发展与思考. 上海医药, 2021, 42(11): 12-14+35.
4. 喻大军. 经肛门全直肠系膜切除术在直肠癌治疗中的研究进展. 中华全科医学, 2021, 19(7): 1196-1198,1205.
5. 魏鹏宇, 李杨, 高加勒, 等. 经肛全直肠系膜切除治疗直肠癌十年回顾与展望. 外科研究与新技术, 2023, 12(1): 1-6.
6. Buess G, Hutterer F, Theiss J, et al. A system for a transanal endoscopic rectum operation. Chirurg, 1984, 55(10): 677-680.
7. Hompes R, Ashraf SQ, Gosselink MP, et al. Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Colorectal Dis, 2015, 17(2): O54-O61. doi: 10.1111/codi.12858.
8. 汪圣毅. 经肛全直肠系膜切除术操作平台的新进展. 中国现代医药杂志, 2023, 25(11): 96-99.
9. Sylla P, Willingham FF, Sohn DK, et al. NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg, 2008, 12(10): 1717-1723.
10. Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc, 2010, 24(5): 1205-1210.
11. Rouanet P, Mourregot A, Azar CC, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum, 2013, 56(4): 408-415.
12. Polese L, Rizzato R, Porzionato A, et al. An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery. Int J Colorectal Dis, 2020, 35(9): 1681-1687.
13. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc, 2010, 24(9): 2200-2205.
14. Kim MJ, Lee TG. Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review. World J Gastrointest Surg, 2021, 13(10): 1149-1165.
15. Hüscher CG, Tierno SM, Romeo V, et al. Technologies, technical steps, and early postoperative results of transanal TME. Minim Invasive Ther Allied Technol, 2016, 25(5): 247-256.
16. Lee TG, Lee SJ. Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia. Surg Endosc, 2014, 28(1): 271-280.
17. Kim MJ, Park JW, Ha HK, et al. Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers. Surg Endosc, 2016, 30(4): 1640-1647.
18. Li YJ, Wang L, Sun TT, et al. Laparoscopy-assisted transanal total mesorectal excision for lower rectal cancer: A feasible and innovative technique. World J Gastrointest Oncol, 2021, 13(1): 12-23.
19. Hawkins AT, Davis BR, Bhama AR, et al. The American Society of colon and rectal surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum, 2024, 67(5): 614-623.
20. 郭紫贤, 何泽玮, 钟世彪. 经肛全直肠系膜切除术在低位直肠癌中的应用进展. 结直肠肛门外科, 2024, 30(3): 389-391,396.
21. 杨选华, 杨华, 任明扬, 等. 经肛门全直肠系膜切除治疗低位直肠癌的安全性和可行性. 西部医学, 2017, 29(7): 958-961,965.
22. Kang L, Chen YG, Zhang H, et al. Transanal total mesorectal excision for rectal cancer: a multicentric cohort study. Gastroenterol Rep (Oxf), 2019, 8(1): 36-41.
23. Maguire L, Sylla P. Transanal endoscopic surgery as a pathway to NOTES. Semin Colon Rectal Surg, 2015, 26(2): 49-57.
24. Araujo SE, Crawshaw B, Mendes CR, et al. Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol, 2015, 19(2): 69-82.
25. Adamina M, Buchs NC, Penna M, et al. St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc, 2018, 32(3): 1091-1103.
26. 王运成, 翟刚, 岑川. 自制平台腔镜下经肛辅助入路全直肠系膜切除术在中低位直肠癌患者中的应用效果. 中国医药导报, 2019, 16(17): 109-112,128.
27. Li W, Dong B, Peng B, et al. Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report. World J Surg Oncol, 2019, 17(1): 202. doi: 10.1186/s12957-019-1744-z.
28. Sali PA, Nandakumar G. Transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS), and transanal total mesorectal excision (TaTME). Clin Colon Rectal Surg, 2024, 37(3): 168-179.
29. Ren J, Liu S, Luo H, et al. Comparison of short-term efficacy of transanal total mesorectal excision and laparoscopic total mesorectal excision in low rectal cancer. Asian J Surg, 2021, 44(1): 181-185.
30. Lei P, Ruan Y, Yang X, et al. Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. Int J Surg, 2018, 60: 113-119.
31. 叶景旺. 经肛门全直肠系膜切除在中低位直肠癌手术治疗中的应用. 重庆: 陆军军医大学, 2019.
32. Ma B, Gao P, Song Y, et al. Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer, 2016, 16: 380. doi: 10.1186/s12885-016-2428-5.
33. Law WL, Foo DCC. Comparison of early experience of robotic and transanal total mesorectal excision using propensity score matching. Surg Endosc, 2019, 33(3): 757-763.
34. Perez D, Melling N, Biebl M, et al. Robotic low anterior resection versus transanal total mesorectal excision in rectal cancer: A comparison of 115 cases. Eur J Surg Oncol, 2018, 44(2): 237-242.
35. Chang TC, Kiu KT. Transanal total mesorectal excision in lower rectal cancer: Comparison of short-term outcomes with conventional laparoscopic total mesorectal excision. J Laparoendosc Adv Surg Tech A, 2018, 28(4): 365-369.
36. Vilaça JDPM. Minimal invasive surgery: Contribution of three dimensional image on single-site endoscopic surgery dissertation. Braga, Portugal: Universidade do Minho, 2021.
37. Liu H, Zeng Z, Zhang H, et al. Morbidity, mortality, and pathologic outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer short-term outcomes from a multicenter randomized controlled trial. Ann Surg, 2023, 277(1): 1-6.
38. Ye J, Tian Y, Li F, et al. Comparison of transanal total mesorectal excision (TaTME) versus laparoscopic TME for rectal cancer: A case matched study. Eur J Surg Oncol, 2021, 47(5): 1019-1025.
39. Hasegawa H, Matsuda T, Yamashita K, et al. Obesity and narrow pelvis prolong the operative time in conventional laparoscopic rectal cancer surgery, but not in a two-team transanal total mesorectal excision approach. Asian J Endosc Surg, 2023, 16(2): 189-196.
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