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Clin Colon Rectal Surg 2022; 35(02): 141-145
DOI: 10.1055/s-0041-1742115
Review Article

Limitations and Concerns with Transanal Total Mesorectal Excision for Rectal Cancer

M. Vannijvel
1   Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
,
Albert M. Wolthuis
1   Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract

Transanal total mesorectal excision (TaTME) was developed to overcome the technical challenges of a minimally invasive (ultra-) low anterior resection. This new technique has recently come under careful scrutiny as technical pitfalls were reported, in specific relation to the transanal approach. Patients are at risk for urologic lesions. Moreover, carbon dioxide embolism is a rare but potentially life-threatening complication. The benefit of TaTME from an oncological point of view has neither been clarified. Hypothetically, better visualization of the lower rectum could lead to better dissection and total mesorectal excision (TME) specimens, resulting in better oncologic results. Up until now, retrospective multicenter reports seem to show that short-term oncologic results are not inferior after TaTME as compared with after laparoscopic TME. Alarming reports have however been published from Norway suggesting a high incidence and particular multifocal pattern of early local recurrence. In this article, a balanced overview is given of the most important technical pitfalls and oncological concerns arising with this new procedure.

Keywords

rectal cancer - transanal total mesorectal excision - complications


Publication History

Article published online:
28 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 van der Pas MH, Haglind E, Cuesta MA. et al; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013; 14 (03) 210-218
    CrossrefPubMedGoogle Scholar
  • 2 Fleshman J, Branda M, Sargent DJ. et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 2015; 314 (13) 1346-1355
    CrossrefPubMedGoogle Scholar
  • 3 Stevenson AR, Solomon MJ, Lumley JW. et al; ALaCaRT Investigators. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. The ALaCaRT randomized clinical trial. JAMA 2015; 314 (13) 1356-1363
    CrossrefPubMedGoogle Scholar
  • 4 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (05) 1205-1210
    CrossrefPubMedGoogle Scholar
  • 5 Roodbeen SX, Penna M, Mackenzie H. et al. Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes. Surg Endosc 2019; 33 (08) 2459-2467
    CrossrefPubMedGoogle Scholar
  • 6 Penna M, Hompes R, Arnold S. et al; International TaTME Registry Collaborative. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision. Ann Surg 2019; 269 (04) 700-711
    CrossrefPubMedGoogle Scholar
  • 7 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 (04) 408-415
    CrossrefPubMedGoogle Scholar
  • 8 Sylla P, Knol JJ, D'Andrea AP. et al. Urethral injury and other urologic injuries during transanal total mesorectal excision: an international collaborative study. Ann Surg 2021; Aug 1; 274 (02) e115-e125 DOI: 10.1097/SLA.0000000000003597.
    CrossrefPubMedGoogle Scholar
  • 9 Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 2015; 19 (02) 57-61
    CrossrefPubMedGoogle Scholar
  • 10 Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol 2016; 20 (07) 483-494
    CrossrefPubMedGoogle Scholar
  • 11 Atallah S, Albert M. The neurovascular bundle of Walsh and other anatomic considerations crucial in preventing urethral injury in males undergoing transanal total mesorectal excision. Tech Coloproctol 2016; 20 (06) 411-412
    CrossrefPubMedGoogle Scholar
  • 12 Atallah S, Larach SW, Monson JR. Stereotactic navigation for TAMIS-TME. Minim Invasive Ther Allied Technol 2016; 25 (05) 271-277
    CrossrefPubMedGoogle Scholar
  • 13 Bell SW. Critical anatomical landmarks in transanal total mesorectal excision (taTME). In: Atallah S. ed. Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME). Springer; 2019: 299-309
    CrossrefGoogle Scholar
  • 14 Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H. Topography of the extrinsic internal anal sphincter nerve supply during laparoscopic-assisted TAMIS TME: five key zones of risk from the surgeons' view. Int J Colorectal Dis 2015; 30 (01) 71-78
    CrossrefPubMedGoogle Scholar
  • 15 Harnsberger CR, Alavi K, Davids JS, Sturrock PR, Zayaruzny M, Maykel JA. CO2 embolism can complicate transanal total mesorectal excision. Tech Coloproctol 2018; 22 (11) 881-885
    CrossrefPubMedGoogle Scholar
  • 16 Shiraishi T, Nishizawa Y, Yamamoto H, Tsukada Y, Sasaki T, Ito M. Carbon dioxide embolism during transanal total mesorectal excision (taTME). Tech Coloproctol 2018; 22 (09) 735-738
    CrossrefPubMedGoogle Scholar
  • 17 Bolshinsky V, Shawki S, Steele S. CO2 embolus during transanal total mesorectal excision: thoughts on aetiology. Colorectal Dis 2019; 21 (01) 6-7
    CrossrefPubMedGoogle Scholar
  • 18 Fernández-Hevia M, Delgado S, Castells A. et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 2015; 261 (02) 221-227
    CrossrefPubMedGoogle Scholar
  • 19 Lelong B, de Chaisemartin C, Meillat H. et al; French Research Group of Rectal Cancer Surgery (GRECCAR). A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design. BMC Cancer 2017; 17 (01) 253
    CrossrefPubMedGoogle Scholar
  • 20 Chen CC, Lai YL, Jiang JK. et al. Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol 2016; 23 (04) 1169-1176
    CrossrefPubMedGoogle Scholar
  • 21 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 (04) 365-369
    CrossrefPubMedGoogle Scholar
  • 22 Perdawood SK, Thinggaard BS, Bjoern MX. Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc 2018; 32 (05) 2312-2321
    CrossrefPubMedGoogle Scholar
  • 23 de Lacy FB, van Laarhoven JJEM, Pena R. et al. Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 2018; 32 (05) 2442-2447
    CrossrefPubMedGoogle Scholar
  • 24 Lacy AM, Tasende MM, Delgado S. et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 2015; 221 (02) 415-423
    CrossrefPubMedGoogle Scholar
  • 25 Park SC, Sohn DK, Kim MJ. et al. Phase II clinical trial to evaluate the efficacy of transanal endoscopic total mesorectal excision for rectal cancer. Dis Colon Rectum 2018; 61 (05) 554-560
    CrossrefPubMedGoogle Scholar
  • 26 Penna M, Hompes R, Arnold S. et al; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 2017; 266 (01) 111-117
    CrossrefPubMedGoogle Scholar
  • 27 Jeong SY, Park JW, Nam BH. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15 (07) 767-774
    CrossrefPubMedGoogle Scholar
  • 28 Deijen CL, Velthuis S, Tsai A. et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 2016; 30 (08) 3210-3215
    CrossrefPubMedGoogle Scholar
  • 29 Jiang HP, Li YS, Wang B. et al. Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis. Surg Endosc 2018; 32 (06) 2632-2642
    CrossrefPubMedGoogle Scholar
  • 30 Rubinkiewicz M, Czerwińska A, Zarzycki P. et al. Comparison of short-term clinical and pathological outcomes after transanal versus laparoscopic total mesorectal excision for low anterior rectal resection due to rectal cancer: a systematic review with meta-analysis. J Clin Med 2018; 7 (11) 448
    CrossrefPubMedGoogle Scholar
  • 31 Aubert M, Mege D, Panis Y. Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach-a meta-analysis. Surg Endosc 2020; 34 (09) 3908-3919
    CrossrefPubMedGoogle Scholar
  • 32 Roodbeen SX, de Lacy FB, van Dieren S. et al; International TaTME Registry Collaborative. Predictive factors and risk model for positive circumferential resection margin rate after transanal total mesorectal excision in 2653 patients with rectal cancer. Ann Surg 2019; 270 (05) 884-891
    CrossrefPubMedGoogle Scholar
  • 33 Simo V, Tejedor P, Jimenez LM. et al. Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study. Surg Endosc 2020; 35 (04) 1808-1819
    CrossrefPubMedGoogle Scholar
  • 34 Hol JC, van Oostendorp SE, Tuynman JB, Sietses C. Long-term oncological results after transanal total mesorectal excision for rectal carcinoma. Tech Coloproctol 2019; 23 (09) 903-911
    CrossrefPubMedGoogle Scholar
  • 35 Larsen SG, Pfeffer F, Kørner H. Norwegian Colorectal Cancer Group. Norwegian moratorium on transanal total mesorectal excision. Br J Surg 2019; 106 (09) 1120-1121
    CrossrefPubMedGoogle Scholar
  • 36 Wasmuth HH, Faerden AE, Myklebust TA. et al; Norwegian TaTME Collaborative Group, on behalf of the Norwegian Colorectal Cancer Group. Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 2020; 107 (01) 121-130
    CrossrefPubMedGoogle Scholar
  • 37 Roodbeen SX, Spinelli A, Bemelman WA. et al. Local recurrence after transanal total mesorectal excision for rectal cancer. A multicenter cohort study. Ann Surg 2020; DOI: 10.1097/SLA.0000000000003757.
    CrossrefPubMedGoogle Scholar
  • 38 Perdawood SK, Kroeigaard J, Eriksen M, Mortensen P. Transanal total mesorectal excision: the Slagelse experience 2013–2019. Surg Endosc 2020; 5 (02) 826-836
    CrossrefPubMedGoogle Scholar
  • 39 Atallah SB, DuBose AC, Burke JP. et al. Uptake of transanal total mesorectal excision in North America: initial assessment of a structured training program and the experience of delegate surgeons. Dis Colon Rectum 2017; 60 (10) 1023-1031
    CrossrefPubMedGoogle Scholar
  • 40 Deijen CL, Tsai A, Koedam TWA. et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 2016; 20 (12) 811-824
    CrossrefPubMedGoogle Scholar
  • 41 Lee L, Kelly J, Nassif GJ, deBeche-Adams TC, Albert MR, Monson JRT. Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma. Surg Endosc 2020; 34 (04) 1534-1542
    CrossrefPubMedGoogle Scholar
  • 42 Koedam TWA, Veltcamp Helbach M, van de Ven PM. et al. Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol 2018; 22 (04) 279-287
    CrossrefPubMedGoogle Scholar
  • 43 Adamina M, Aigner F, Araujo S. et al; TaTME Guidance Group representing the ESCP (European Society of Coloproctology), in collaboration with the ASCRS (American Society of Colon and Rectal Surgeons), ACPGBI (Association of Coloproctology of Great Britain and Ireland), ECCO (European Crohn's and Colitis Organisation), EAES (European Association of Endoscopic Surgeons), ESSO (European Society of Surgical Oncology), CSCRS (Canadian Society of Colorectal Surgery), CNSCRS (Chinese Society of Colorectal Surgery), CSLES (Chinese Society of Laparo-Endoscopic Surgery), CSSANZ (Colorectal Surgical Society of Australia and New Zealand), JSES (Japanese Society of Endoscopic Surgery), SACP (Argentinian Society of Coloproctology), SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), SBCP (Brazilian Society of Coloproctology), Swiss-MIS (Swiss Association for Minimally Invasive Surgery). International expert consensus guidance on indications, implementation and quality measures for transanal total mesorectal excision. Colorectal Dis 2020; 22 (07) 749-755
    CrossrefPubMedGoogle Scholar