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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11700-11708
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11700
Transanal total mesorectal excision: A valid option for rectal cancer?
Nicolas C Buchs, Gary A Nicholson, Frederic Ris, Neil J Mortensen, Roel Hompes
Nicolas C Buchs, Gary A Nicholson, Neil J Mortensen, Roel Hompes, Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, OX3 7LE Oxford, United Kingdom
Nicolas C Buchs, Frederic Ris, Division of Visceral Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
Gary A Nicholson, Neil J Mortensen, Nuffield Department of Surgical Science, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, United Kingdom
Author contributions: Buchs NC and Hompes R designed the research; Buchs NC, Nicholson GA and Hompes R performed the research (acquisition of data); Buchs NC, Ris F, Mortensen NJ and Hompes R analyzed and interpreted the data; Buchs NC, Nicholson GA and Hompes R wrote the article; Nicholson GA, Ris F and Mortensen NJ revised the article; all authors gave their final approval.
Conflict-of-interest statement: Roel Hompes is a regular faculty member for TAMIS courses organized by Applied Medical. The other authors have no financial disclosure or 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: Nicolas C Buchs, MD, Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Old Road, OX3 7LE Oxford, United Kingdom. nicolas.c.buchs@hcuge.ch
Telephone: +44-18-65741841 Fax: +44-18-65235857
Received: April 21, 2015
Peer-review started: April 22, 2015
First decision: July 13, 2015
Revised: July 21, 2015
Accepted: September 14, 2015
Article in press: September 14, 2015
Published online: November 7, 2015
Abstract

Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision (TaTME) might offer technical advantages over laparoscopic or open approaches particularly for tumors in the distal third of the rectum. The aim of this article is to review the current experience with TaTME. The limits and future developments are also explored. Although the experience with TaTME is still limited, it might be a promising alternative to laparoscopic TME, especially for difficult cases where laparoscopy is too demanding. The preliminary data on complications and short-term oncological outcomes are good, but also emphasize the importance of careful patient selection. Finally, there is a need for large-scale trials focusing on long-term outcomes and oncological safety before widespread adoption can be recommended.

Keywords: Transanal, Bottom up, Transanal minimally invasive surgery, Laparoscopy, Robotic, Outcomes, Rectal cancer, Total mesorectal excision

Core tip: The current literature regarding transanal total mesorectal excision of the rectum (TaTME) is presented. Outcomes are encouraging. TaTME might be a promising alternative to laparoscopic TME, especially for difficult cases where laparoscopy is too demanding. The limitations and future developments are explored.