Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12686-12695
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12686
Transanal total mesorectal excision: Towards standardization of technique
Albert M Wolthuis, Gabriele Bislenghi, Anthony de Buck van Overstraeten, André D’Hoore
Albert M Wolthuis, Gabriele Bislenghi, Anthony de Buck van Overstraeten, André D’Hoore, Department of Abdominal Surgery, University Hospital Leuven, 3000 Leuven, Belgium
Author contributions: Wolthuis AM and D’Hoore A designed the study; Wolthuis AM, Bislenghi G and de Buck van Overstraeten A performed the study; Wolthuis AM and Bislenghi G analysed the data; Wolthuis AM, Bislenghi G, de Buck van Overstraeten A and D’Hoore A wrote the paper.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Albert M Wolthuis, MD, Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. albert.wolthuis@uzleuven.be
Telephone: +32-16-344265 Fax: +32-16-344832
Received: May 16, 2015
Peer-review started: May 20, 2015
First decision: July 14, 2015
Revised: August 1, 2015
Accepted: October 23, 2015
Article in press: October 26, 2015
Published online: November 28, 2015
Abstract

AIM: To describe the role of Transanal total mesorectal excision (TaTME) in minimally invasive rectal cancer surgery, to examine the differences in patient selection and in reported surgical techniques and their impacts on postoperative outcomes and to discuss the future of TaTME.

METHODS: MEDLINE (PubMed), EMBASE, and The Cochrane Library were systematically searched through the 1st of March 2015 using a predefined search strategy.

RESULTS: A total of 20 studies with 323 patients were included. Most studies were single-arm prospective studies with fewer than 100 patients. Multiple transanal access platforms were used, and the laparoscopic approach was either multi- or single port. The procedure was initiated transanally or transabdominally. If a simultaneous approach with 2 operating surgeons was chosen, the operative time was significantly reduced.

CONCLUSION: TaTME was also associated with better TME specimens and a longer distal resection margin. TaTME is thus feasible in expert hands, but the learning curve and safety profile are not well defined. Long-term follow-up regarding anal function and oncological outcomes should be performed in the future.

Keywords: Laparoscopy, Colorectal surgery, Rectal cancer, Total mesorectal excision, Transanal total mesorectal excision, Natural orifice specimen extraction, Transanal, Transanal minimally invasive surgery, Reverse total mesorectal excision

Core tip: Transanal total mesorectal excision (TaTME) is a result of recent developments in transanal endoscopic microsurgery, transanal minimally invasive surgery, natural orifice specimen extraction, natural orifice transluminal endoscopic surgery, transanal abdominal transanal proctosigmoidectomy, and laparoscopic total mesorectal excision. TaTME is an exciting convergence of various existing surgical techniques that represents the future of rectal cancer surgery. A substantial number of patients, and especially obese males with a narrow pelvis, will benefit from this minimally invasive approach. This systematic review addresses all aspects of TaTME and discusses the advantages and disadvantages of this technique. Different surgical approaches are used, but it is clear that experience with TaTME is increasing worldwide. Standardization of the technique and reporting of outcomes is required.