Download PDF
Clin Colon Rectal Surg 2017; 30(02): 120-129
DOI: 10.1055/s-0036-1597314
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transanal Total Mesorectal Excision: A Novel Approach to Rectal Surgery

Pasithorn A. Suwanabol
1   Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Justin A. Maykel
2   Division of Colorectal Surgery, Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
04 April 2017 (online)

    Permissions and Reprints

Abstract

Less invasive approaches continue to be explored and refined for diseases of the colon and rectum. The current gold standard for the surgical treatment of rectal cancer, total mesorectal excision (TME), is a technically precise yet demanding procedure with outcomes measured by both oncologic and functional outcomes (including bowel, urinary, and sexual). To date, the minimally invasive approach to rectal cancer has not yet been perfected, leaving ample opportunity for rectal surgeons to innovate. Transanal TME has recently emerged as a safe and effective technique for both benign and malignant diseases of the rectum. While widespread acceptance of this surgical approach remains tempered at this time due to lack of long-term oncologic outcome data, short-term outcomes are promising and there is great excitement surrounding the promise of this technique.

Keywords

total mesorectal excision - transanal - rectal cancer
 

  • References

  • 1 Heald RJ. A new approach to rectal cancer. Br J Hosp Med 1979; 22 (3) 277-281
    PubMedGoogle Scholar
  • 2 Heald RJ. A new solution to some old problems: transanal TME. Tech Coloproctol 2013; 17 (3) 257-258
    CrossrefPubMedGoogle Scholar
  • 3 Weaver KL, Grimm Jr LM, Fleshman JW. Changing the way we manage rectal cancer-standardizing TME from open to robotic (including laparoscopic). Clin Colon Rectal Surg 2015; 28 (1) 28-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Wibe A, Møller B, Norstein J , et al; Norwegian Rectal Cancer Group. A national strategic change in treatment policy for rectal cancer--implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002; 45 (7) 857-866
    CrossrefPubMedGoogle Scholar
  • 5 Hasegawa S, Takahashi R, Hida K, Kawada K, Sakai Y. Transanal total mesorectal excision for rectal cancer. Surg Today 2016; 46 (6) 641-653
    CrossrefPubMedGoogle Scholar
  • 6 Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996; 182 (6) 495-502
    PubMedGoogle Scholar
  • 7 Guillou PJ, Quirke P, Thorpe H , et al; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365 (9472) 1718-1726
    CrossrefPubMedGoogle Scholar
  • 8 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 (3) 210-218
    CrossrefPubMedGoogle Scholar
  • 9 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
  • 10 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
  • 11 Sun Z, Kim J, Adam MA , et al. Minimally invasive versus open low anterior resection: equivalent survival in a national analysis of 14,033 patients with rectal cancer. Ann Surg 2016; 263 (6) 1152-1158
    CrossrefPubMedGoogle Scholar
  • 12 Maykel JA. Laparoscopic transanal total mesorectal excision (taTME) for rectal cancer. J Gastrointest Surg 2015; 19 (10) 1880-1888
    CrossrefPubMedGoogle Scholar
  • 13 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 (2) 415-423
    CrossrefPubMedGoogle Scholar
  • 14 Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 2008; 23 (7) 703-707
    CrossrefPubMedGoogle Scholar
  • 15 Dumont F, Goéré D, Honoré C, Elias D. Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 2012; 55 (9) 996-1001
    CrossrefPubMedGoogle Scholar
  • 16 Maslekar S, Pillinger SH, Monson JR. Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 2007; 21 (1) 97-102
    CrossrefPubMedGoogle Scholar
  • 17 Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH ; Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002; 20 (7) 1729-1734
    CrossrefPubMedGoogle Scholar
  • 18 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (5) 1205-1210
    CrossrefPubMedGoogle Scholar
  • 19 Marks J, Nassif G, Schoonyoung H , et al. Sphincter-sparing surgery for adenocarcinoma of the distal 3 cm of the true rectum: results after neoadjuvant therapy and minimally invasive radical surgery or local excision. Surg Endosc 2013; 27 (12) 4469-4477
    CrossrefPubMedGoogle Scholar
  • 20 Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg 2014; 260 (6) 993-999
    CrossrefPubMedGoogle Scholar
  • 21 Marks J, Mizrahi B, Dalane S, Nweze I, Marks G. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 2010; 24 (11) 2700-2707
    CrossrefPubMedGoogle Scholar
  • 22 de'Angelis N, Portigliotti L, Azoulay D, Brunetti F. Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbecks Arch Surg 2015; 400 (8) 945-959
    CrossrefPubMedGoogle Scholar
  • 23 Motson RW, Whiteford MH, Hompes R , et al. Current status of trans-anal total mesorectal excision (TaTME) following the 2nd International consensus conference. Colorectal Dis 2016; 18 (1) 13-18
    PubMedGoogle Scholar
  • 24 Atallah S, Martin-Perez B, Albert M , et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 2014; 18 (5) 473-480
    CrossrefPubMedGoogle Scholar
  • 25 Tuech JJ, Karoui M, Lelong B , et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 2015; 261 (2) 228-233
    CrossrefPubMedGoogle Scholar
  • 26 Wolthuis AM, de Buck van Overstraeten A, D'Hoore A. Dynamic article: transanal rectal excision: a pilot study. Dis Colon Rectum 2014; 57 (1) 105-109
    CrossrefPubMedGoogle Scholar
  • 27 Wolthuis AM, Cini C, Penninckx F, D'Hoore A. Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis. Tech Coloproctol 2012; 16 (2) 161-165
    CrossrefPubMedGoogle Scholar
  • 28 Leroy J, Barry BD, Melani A, Mutter D, Marescaux J. No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg 2013; 148 (3) 226-230 , discussion 231
    CrossrefPubMedGoogle Scholar
  • 29 Chouillard E, Chahine E, Khoury G , et al. NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 2014; 28 (11) 3150-3157
    CrossrefPubMedGoogle Scholar
  • 30 Gómez Ruiz M, Parra IM, Palazuelos CM , et al. Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 2015; 58 (1) 145-153
    CrossrefPubMedGoogle Scholar
  • 31 Zhang H, Zhang YS, Jin XW, Li MZ, Fan JS, Yang ZH. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 2013; 17 (1) 117-123
    CrossrefPubMedGoogle Scholar
  • 32 Zorron R, Phillips HN, Coelho D, Flach L, Lemos FB, Vassallo RC. Perirectal NOTES access: “down-to-up” total mesorectal excision for rectal cancer. Surg Innov 2012; 19 (1) 11-19
    CrossrefPubMedGoogle Scholar
  • 33 Verheijen PM, Consten EC, Broeders IA. Robotic transanal total mesorectal excision for rectal cancer: experience with a first case. Int J Med Robot 2014; 10 (4) 423-426
    CrossrefPubMedGoogle Scholar
  • 34 Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 2015; 41 (4) 478-483
    CrossrefPubMedGoogle Scholar
  • 35 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 (4) 408-415
    CrossrefPubMedGoogle Scholar
  • 36 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 (2) 221-227
    CrossrefPubMedGoogle Scholar
  • 37 Atallah S, Martin-Perez B, Pinan J , et al. Robotic transanal total mesorectal excision: a pilot study. Tech Coloproctol 2014; 18 (11) 1047-1053
    CrossrefPubMedGoogle Scholar
  • 38 Cahill RA. Single port surgery for rectal cancer-going up or down?. Dis Colon Rectum 2013; 56 (11) 1199-1200
    CrossrefPubMedGoogle Scholar
  • 39 Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C. Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 2014; 28 (12) 3494-3499
    CrossrefPubMedGoogle Scholar
  • 40 Atallah S, Albert M, DeBeche-Adams T, Nassif G, Polavarapu H, Larach S. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 2013; 17 (3) 321-325
    CrossrefPubMedGoogle Scholar
  • 41 Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 2015; 19 (2) 57-61
    CrossrefPubMedGoogle Scholar
  • 42 Bülow S, Christensen IJ, Iversen LH, Harling H ; Danish Colorectal Cancer Group. Intra-operative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Colorectal Dis 2011; 13 (11) 1256-1264
    CrossrefPubMedGoogle Scholar
  • 43 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 (8) 3210-3215
    CrossrefPubMedGoogle Scholar
  • 44 Funahashi K, Koike J, Teramoto T , et al. Transanal rectal dissection: a procedure to assist achievement of laparoscopic total mesorectal excision for bulky tumor in the narrow pelvis. Am J Surg 2009; 197 (4) e46-e50
    PubMedGoogle Scholar
  • 45 Gaujoux S, Bretagnol F, Au J, Ferron M, Panis Y. Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis 2011; 13 (9) e305-e307
    CrossrefPubMedGoogle Scholar
  • 46 Tuech JJ, Bridoux V, Kianifard B , et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol 2011; 37 (4) 334-335
    CrossrefPubMedGoogle Scholar
  • 47 Han Y, He YG, Zhang HB , et al. Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China. Surg Endosc 2013; 27 (2) 518-524
    CrossrefPubMedGoogle Scholar
  • 48 Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner DW. Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surg Endosc 2013; 27 (1) 339-346
    CrossrefPubMedGoogle Scholar
  • 49 Velthuis S, van den Boezem PB, van der Peet DL, Cuesta MA, Sietses C. Feasibility study of transanal total mesorectal excision. Br J Surg 2013; 100 (6) 828-831 , discussion 831
    CrossrefPubMedGoogle Scholar
  • 50 Choi BJ, Lee SC, Kang WK. Single-port laparoscopic total mesorectal excision with transanal resection (transabdominal transanal resection) for low rectal cancer: initial experience with 22 cases. Int J Surg 2013; 11 (9) 858-863
    CrossrefPubMedGoogle Scholar
  • 51 de Lacy AM, Rattner DW, Adelsdorfer C , et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)--short-term outcomes in the first 20 cases. Surg Endosc 2013; 27 (9) 3165-3172
    CrossrefPubMedGoogle Scholar
  • 52 Sylla P, Bordeianou LG, Berger D , et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 2013; 27 (9) 3396-3405
    CrossrefPubMedGoogle Scholar
  • 53 Meng W, Lau K. Synchronous laparoscopic low anterior and transanal endoscopic microsurgery total mesorectal resection. Minim Invasive Ther Allied Technol 2014; 23 (2) 70-73
    CrossrefPubMedGoogle Scholar
  • 54 Zorron R, Phillips HN, Wynn G, Neto MP, Coelho D, Vassallo RC. “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: preliminary series of 9 patients. J Minim Access Surg 2014; 10 (3) 144-150
    CrossrefPubMedGoogle Scholar
  • 55 Huscher CG, Bretagnol F, Ponzano C. Robotic-assisted transanal total mesorectal excision: the key against the Achilles' heel of rectal cancer?. Ann Surg 2015; 261 (5) e120-e121
    CrossrefPubMedGoogle Scholar
  • 56 Knol JJ, D'Hondt M, Souverijns G, Heald B, Vangertruyden G. Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below--a preliminary report. Tech Coloproctol 2015; 19 (4) 221-229
    CrossrefPubMedGoogle Scholar