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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(02): 159-166
DOI: 10.1055/s-0042-1743245
Original Article

A Way to Start Transanal Total Mesorectal Excision for Rectal Cancer

Ruben Martins 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Tatiana Revez 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Henrique Morais 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Pedro Henriques 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Nicole Cardoso 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Isabel Manso 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Lina Leote 
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
,
Martins dos Santos
1   General Surgery Department, Faro Hospital, Centro Hospitalar e Universitário do Algarve (CHUA), Faro, Portugal
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Abstract

Introduction The optimal rectal cancer care is achieved by a multidisciplinary approach, with a high-quality surgical resection, with complete mesorectal excision and adequate margins. New approaches like the transanal total mesorectal excision (TaTME) aim to achieve these goals, maximizing the sphincter preservation ratio, with good oncologic and functional results. This report describes a way to implement TaTME without a proctor, presents the first case series of this approach in a center experienced in rectal cancer, and compares the results with those of the international literature.

Methods We performed a retrospective study of the first 10 consecutive patients submitted to TaTME for rectal cancer at our institution. The primary outcomes were postoperative complications, pathological specimen quality and local recurrence rate. The results and performance were compared with the outcomes of a known structured program with proctorship and with the largest meta-analysis on this topic.

Results All patients had locally advanced cancer; therefore, all underwent neoadjuvant therapy. A total of 30% had postoperative complications, without mortality or re-admissions. In comparison with the structured training program referred, no differences were found in postoperative complications and reintervention rates, resulting in a similar quality of resection. Comparing these results with those of the largest meta-analysis on the subject, no differences in the postoperative complication rates were found, and very similar outcomes regarding anastomotic leaks and oncological quality of resection were registered.

Conclusion The results of this study validate the safety and effectiveness of our pathway regarding the implementation of the TaTME approach, highlighting the fact that it should be done in a center with proficiency in minimally invasive rectal surgery.

Keywords

rectal - cancer - surgery - trans-anal - formation


Publication History

Received: 21 October 2021

Accepted: 13 January 2022

Article published online:
19 April 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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