• Laparoscopic
• Meta-analysis
• Rectal cancer
• Total mesorectal excision
• Transanal

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Laparoscopy/methods
• Postoperative Complications/epidemiology
• Transanal Endoscopic Surgery/methods
• Proctectomy/methods
• Margins of Excision
• Treatment Outcome
• Conversion to Open Surgery/statistics & numerical data

• TaTME
• Total mesorectal excision
• meta-analysis
• outcomes
• rectal cancer
• robot
• robot-assisted
• systematic review
• transanal

• Humans
• Rectal Neoplasms/surgery
• Robotic Surgical Procedures/methods
• Proctectomy/methods
• Transanal Endoscopic Surgery/methods
• Margins of Excision
• Rectum/surgery
• Postoperative Complications/epidemiology
• Treatment Outcome

• Laparoscopic total mesorectal excision
• Local recurrence
• Rectal cancer
• Survival
• Transanal total mesorectal excision

• Humans
• Cohort Studies
• Propensity Score
• Retrospective Studies
• Proctectomy
• Rectal Neoplasms/surgery

• outcomes research
• colorectal cancer

• Male
• Humans
• Female
• Aged
• Rectum/surgery
• Laparoscopy/methods
• Rectal Neoplasms/surgery
• Rectal Neoplasms/complications
• Proctectomy/methods
• Administration, Rectal
• Treatment Outcome
• Postoperative Complications/etiology

• diagnosis
• multimodal therapy
• rectal cancer
• stratification
• surgery

• TME
• intersphincteric resection
• laparoscope
• low rectal cancer
• transanal total mesorectal excision

• Laparoscopic
• Pathologic outcome. Transanal
• Rectal cancer
• Total mesorectal excision

• Clinical practice guideline
• EAES
• GRADE
• Rectal cancer
• TaTME
• Transanal TME

• GRADE Approach
• Humans
• Laparoscopy/methods
• Postoperative Complications/surgery
• Proctectomy
• Rectal Neoplasms/surgery
• Rectum/surgery
• Transanal Endoscopic Surgery/methods

• european association for endoscopic surgery and other interventional techniques
• united european gastroenterology

Total mesorectal excision (TME) performed for the first time by Held through an open approach, it has become the standard technique for the surgical treatment of rectal cancer. The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME.

In this meta-analysis, we included all comparative studies, prospective and retrospective, which addressed in low and middle rectal cancer, a comparison between TaTME and LaTME. A search was performed through MEDLINE and Cochrane Database. 846 records were identified.

Eight relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt. The eight studies including 471 patients with middle or low rectal cancer.

The meta-analysis confirmed safety of TaTME for low and middle rectal cancer. TaTME can lead to a high quality of rectal cancer resection specimen.

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The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME.

• Oncological outcomes
• Rectal cancer
• TaTME
• lapTME

• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Rectal Neoplasms/pathology
• Rectum/pathology
• Rectum/surgery
• Transanal Endoscopic Surgery/adverse effects
• Transanal Endoscopic Surgery/methods
• Treatment Outcome

• Hybrid surgery
• Laparoscopic surgery
• Rectal cancer
• Robotic surgery
• Transanal total mesorectal excision (TaTME)

• laparoscopic
• quality of surgical resection
• rectal cancer
• robotic
• transanal

• Neoadjuvant chemoradiotherapy
• Rectal cancer
• Robotic TME
• Total mesorectal excision
• Transanal TME

• rectal cancer
• total mesorectal excision
• transanal total mesorectal excision

For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME).

Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence.

A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1–6.1) in the TaTME group and 9.6% (95% CI, 6.5–12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23–0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8–79.8) and 68.6% (95% CI, 63.7–73.5) (HR = 0.82; 95% CI, 0.65–1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7–91.7) and 82.2% (95% CI, 78.0–86.2) (HR = 0.74; 95% CI, 0.53–1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62–0.98; p = 0.033).

These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.

• Locoregional recurrence
• Rectal cancer
• TaTME
• Total mesorectal excision

• Laparoscopic
• Rectal cancer
• Total mesorectal excision
• Transanal

• Aged
• Anal Canal/surgery
• Anastomotic Leak/etiology
• Conversion to Open Surgery
• Female
• Humans
• Intraoperative Complications/etiology
• Laparoscopy/adverse effects
• Lymph Nodes/pathology
• Male
• Middle Aged
• Observational Studies as Topic
• Postoperative Complications/etiology
• Publication Bias
• Rectal Neoplasms/surgery
• Rectum/surgery
• Risk
• Surgical Wound Infection/etiology
• Time Factors

Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.

From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.

The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).

In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

• Incisions
• Outcomes
• Rectal neoplasms
• Specimen extraction

• Quality of life (QoL)
• bowel dysfunction
• health status
• rectal cancer

• laparoscopic
• multicentric
• rectal cancer
• total mesorectal excision
• transanal

• Anastomotic leakage
• Postoperative morbidity
• Rectal cancer

McKittrick–Wheelock syndrome (MKWS) is caused by a villous tumor of the rectosigmoid colon with hypersecretion of mucus containing electrolytes. Complete resection of the tumor is needed to cure this disease. Transanal total mesorectal excision (TaTME) is currently a promising treatment for lower rectal tumor because of the reliability of its resection margin especially in bulky tumor. We present this first case report of a TaTME for MKWS with a lower rectal tumor.

An 81-year-old woman was admitted to our hospital with diarrhea and acute renal failure. Computed tomography and magnetic resonance imaging examinations revealed an 80-mm-sized enhanced tumor located in her lower rectum without lymph node swelling and distant metastasis. A giant villous tumor secreting mucus was seen in the lower rectum to the anal canal during colonoscopy. The result of tumor biopsy was adenocarcinoma. To preserve the anal function and ensure distal margin, we chose TaTME for curative resection. After improving the electrolyte imbalance, TaTME was performed successfully and R0 resection was achieved. There was no sign of recurrence or electrolyte depletion for 1 year after the surgery.

TaTME could be a promising surgical approach for giant villous tumor with MKWS in the lower rectum.

• Lower rectal cancer
• McKittrick–Wheelock syndrome
• Total mesorectal incision
• Transanal total mesorectal excision
• Villous tumor

• Hybrid surgery
• Pelvic malignancy
• Rectal cancer
• Robotic surgery
• Sphincter preservation
• TaTME
• Total mesorectal excision

• Laparoscopy
• Meta-analysis
• Rectal cancer
• Total mesorectal excision
• Transanal total mesorectal excision

Transanal total mesorectal excision (TaTME) for mid and low rectal cancer has been shown to improve short-term outcomes, mostly due to lower conversion rates and with improved quality of the specimen. However, robust long-term oncological data supporting the encouraging clinical and pathological outcomes are lacking.

All consecutive patients undergoing TaTME with curative intent for mid or low rectal cancer in two referral centers in The Netherlands between January 2012 and April 2016 with a complete and minimum follow-up of 36 months were included. The primary outcome was local recurrence rate. Secondary outcomes were disease-free survival, overall survival and development of metastasis.

There were 159 consecutive patients. Their mean age was 66.9 (10.2) years and 66.7% of all patients were men. Pathological analysis showed a complete mesorectum in 139 patients (87.4%), nearly complete in 16 (10.1%) and an incomplete mesorectum in 4 (2.5%). There was involvement of the CRM (< 1 mm) in one patient (0.6%) and no patients had involvement of the distal margin (< 5 mm). Final postoperative staging after neoadjuvant therapy was stage 0 in 11 patients (6.9%), stage I in 73 (45.9%), stage II in 31 (19.5%), stage III in 37 (23.3%) and stage IV in 7 (4.4%). The 3-year local recurrence rate was 2.0% and the 5-year local recurrence rate was 4.0%. Median time to local recurrence was 19.2 months. Distant metastases were found in 22 (13.8%) patients and were diagnosed after a median of 6.9 months (range 1.1–50.4) months. Disease-free survival was 92% at 3 years and 81% at 5 years. Overall survival was 83.6% at 3 years and 77.3% at 5 years.

The long-term follow-up of the current cohort confirms the oncological safety and feasibility of TaTME in two high volume referral centers for rectal carcinoma. However, further robust and audited data must confirm current findings before widespread implementation of TaTME.

• Colorectal cancer
• Long-term results
• Transanal TME

• Aged
• Anal Canal
• Carcinoma/pathology
• Carcinoma/secondary
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Male
• Mesentery/surgery
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local/etiology
• Neoplasm Staging
• Proctectomy/methods
• Radiotherapy, Adjuvant
• Rectal Neoplasms/pathology
• Rectal Neoplasms/therapy
• Risk Factors
• Survival Rate
• Time Factors

• Rectal cancer
• Surgical training
• Surgical videos
• TaTME
• Transanal total mesorectal excision

• Minimally-invasive surgery
• Rectal cancer
• Rectal surgery
• Robotic transanal surgery
• TME

Colorectal cancer is ranked as the fourth malignant cause of mortality. With the tremendous revolution in the modern medical techniques, minimally invasive approaches have been incorporated into rectal surgery. The effectiveness of surgical procedures is usually measured by a combination of qualitative (quality of life) and quantitative (years of life) measures, while the costs should reflect the use of different resources that were involved in delivering the medical care and they are affected by several factors, including length of hospital stay. In this review, we provide an insight into the cost-effectiveness of the different types of rectal surgeries in order to present a systematic approach for future preferences. A comprehensive literature review using Medline (via PUBMED), Embase and Cochrane Central Register of clinical trials (via clinical trial.org) was performed. Minimally invasive rectal surgeries have considerable cost-effective properties that outweigh those of the open techniques in terms of earlier return to bowel function, lower morbidity rates, reduced pain, shorter length of hospital stay and the overall patients’ quality of life although there was no difference in long-term oncological and survival outcomes. The paucity of currently available long-term oncologic, quality of life, and economic outcomes may limit an adequate comparison of robotic surgeries to other surgical techniques. It is therefore recommended to conduct focused studies to help balance the cost/benefit factors along with other technical considerations aimed at reducing the cost of robotic systems with subsequent improvement of their cost-effectiveness.

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Colorectal cancer is the fourth cause of mortality. Minimally invasive surgery is now considered the standard of care.

• Colorectal
• Cost-effectiveness
• Laparoscopy
• Rectal surgery
• Robotics
• TaTME

• Ileal pouch-anal anastomosis
• transanal proctectomy
• ulcerative colitis

To evaluate the safety and feasibility of transanal endoscopic surgery for diffuse cavernous hemangioma of the rectum (DCHR).

All DCHR patients who underwent transanal endoscopic surgery in our hospital between January 2014 and June 2018 were reviewed.

A total of 7 patients with a diagnosis of DCHR underwent transanal endoscopic surgery during the study period. Four patients (57.1%) were male, with a mean age at surgery of 34.5 ± 7.7 years, and three patients (42.9%) were female, with a mean age at surgery of 29.9 ± 3.8 years. Recurrent painless rectal bleeding was the main symptom in all patients. The mean age was 32 years old (range 21-54 years). The median duration of symptoms was 10 years (range 1 month-50 years). The level of hemoglobin at admission ranged from 59.0 to 148.0 g/l (mean 106.6 g/l), and the level of mean corpuscular volume (MCV) ranged from 75.1 fl to 93.5 fl (mean 83.7 fl). Colonoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) were important in the diagnosis of DCHR because of their high positive rates and accurate features. All of the lesions are between the anal canal and the descending colon. Two patients could be found with some enlarged serpentine vessels in the cervix, vagina, or corpus cavernosum by MRI. After admission, all the patients underwent transanal endoscopic surgery and four patients had simultaneous loop ileostomy. The mean operative time was 278 min (range 168-400 min). The median amount of intraoperative blood loss was 50 ml (range 10-300 ml). The mean distance from anal verge to anastomosis was 2.2 ± 0.2 cm. The anastomosis was fashioned with a stapler in two patients (28.6%). There were no intraoperative and postoperative complications. All the patients continued to recover well from the surgery, and nobody needed postoperative blood transfusions.

The specific diagnosis rate of DCHR is low. Preoperative MRI and CT examination can make a definitive diagnosis and determine the extent of the lesions. DCHR is mostly restricted to the rectum, sigmoid colon, anal wall, and mesorectum. The best treatment for DCHR is complete lesion resection. It is safe and feasible to treat DCHR using transanal endoscopic surgery. Moreover, transanal endoscopic surgery might have a huge potential when used to treat other rectal diseases.

• laparoscopic colorectal surgery
• rectal cancer
• robotic colorectal surgery
• total mesorectal excision

• Cytoreduction Surgical Procedures/methods
• Humans
• Minimally Invasive Surgical Procedures/methods
• Randomized Controlled Trials as Topic
• Rectal Neoplasms/surgery
• Treatment Outcome

• Minimally invasive
• Rectal cancer
• Surgery
• Total mesorectal excision
• taTME

• NOTES
• Rectal cancer
• Transanal TME

• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Rectal Neoplasms/surgery
• Transanal Endoscopic Surgery/methods
• Treatment Outcome

• Quality of life
• Rectal cancer
• Surgery
• TAMIS
• Transanal TME

Introduction: The TaTME surgery has been developed to overcome the difficulties encountered in the practice of laparoscopic surgery for rectal cancer, especially in male, obese patients with a narrow pelvis and mid and low rectal tumours. Although the TaTME shows some promising results regarding oncological and operative outcomes, some pitfalls have been indicated. Thus, the real benefits of this novel technique over the laparoscopic surgery remain unknown. The aim of the present study was to perform a systematic review and meta-analysis of the currently available literature on the outcomes of TaTME in comparison with laparoscopic procedure.

Methods: A systematic literature search was conducted using the web-based databases MEDLINE, EMBASE, and Cochrane CENTRAL, followed by a manual search of the references of the initially identified articles. The study information, patient characteristics, oncological outcomes, perioperative outcomes, as well as short- and long-term postoperative outcomes were collected and critically evaluated.

Results: Nine retrospective cohort studies were identified, comprising 751 patients (348 with TaTME, 403 with LaTME). The positive circumferential resection margin (P = 0.01) was better in patients treated with TaTME; whereas the quality of mesorectum, circumferential resection margin, distal resection margin, and harvested lymph nodes were comparable. The TaTME was associated with shorter operative time (P = 0.05; P = 0.0006 in subgroup analysis), less blood loss (P = 0.02), less conversion (P = 0.007), and shorter hospital stay (P = 0.06; P = 0.003 in subgroup analysis). The intraoperative complications were similar. As for the postoperative outcomes, the overall postoperative complications (P = 0.02) and the readmission (P = 0.003) were found less in patients treated with TaTME; however, the individual postoperative complications were found comparable.

Conclusion: The present systematic review and meta-analysis suggested some advantages of TaTME, in terms of circumferential resection margin involvement, operative time, blood loss, conversion, hospital stay, overall postoperative complications, and readmission. It appears that the TaTME procedure achieved a better resection quality and smoother recovery in selected patients, without compromising the short-term safety. Nevertheless, it is too early to draw any conclusion, since results of high quality clinical evidence from randomized controlled trials have to be awaited. As it is technically demanding, the procedure needs to be taught and learned systematically to ensure safe implementation.

• comparison
• laparoscopic
• meta-analysis
• rectal cancer
• systematic review
• transanal total mesorectal excision

• Cancer
• MRI
• Mesorectal excision
• Rectum
• TaTME