Transanal Total Mesorectal Excision: Why, When, and How

Abstract

Transanal total mesorectal excision (taTME) has evolved over the past decade fueled by advances in minimally invasive surgery. The technique aims to overcome the constraints posed by a narrow rigid pelvis and poor TME visualization that are encountered during “top-down” rectal surgery. A more accurate pelvic dissection should subsequently result in safer oncological resections and better preservation of pelvic autonomic nerves. taTME is an advanced complex technique that requires dedicated training and experience in TME surgery. Initial results from small cohorts are promising and confirmation by randomized controlled trials is eagerly awaited.

Keywords

transanal - bottom-up - total mesorectal excision - rectal cancer

• References

• 1 World Cancer Research Fund and American Institute for Cancer Research Food. Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research; 2007
• 2 Heald RJ. A new approach to rectal cancer. Br J Hosp Med 1979; 22 (03) 277-281
• 3 Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998; 133 (08) 894-899
• 4 Buess G, Theiss R, Hutterer F. , et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments [in German]. Leber Magen Darm 1983; 13 (02) 73-77
• 5 Marks JH, Frenkel JL, D'Andrea AP, Greenleaf CE. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am 2011; 20 (03) 501-520 , viii–ix
• 6 Rattner D, Kalloo A. ; ASGE/SAGES Working Group. ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 2006; 20 (02) 329-333
• 7 Whiteford MH, Denk PM, Swanström LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 2007; 21 (10) 1870-1874
• 8 Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010; 24 (09) 2200-2205
• 9 Sylla P, Willingham FF, Sohn DK, Gee D, Brugge WR, Rattner DW. NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg 2008; 12 (10) 1717-1723
• 10 Trunzo JA, Delaney CP. Natural orifice proctectomy using a transanal endoscopic microsurgical technique in a porcine model. Surg Innov 2010; 17 (01) 48-52
• 11 Telem DA, Han KS, Kim MC. , et al. Transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series. Surg Endosc 2013; 27 (01) 74-80
• 12 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
• 13 Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2006; (04) CD005200
• 14 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
• 15 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
• 16 Jayne DG, Guillou PJ, Thorpe H. , et al; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25 (21) 3061-3068
• 17 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
• 18 RObotic Versus LAparoscopic Resection for Rectal Cancer (ROLARR) trial. (ClinicalTrials.gov ID: NCT01736072). Available at: https://www.fascrs.org/video/robotic-vs-laparoscopic-resection-rectal-cancer-rolarr-trial . Accessed January 4, 2016
• 19 Targarona EM, Balague C, Pernas JC. , et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg 2008; 247 (04) 642-649
• 20 Oh SJ, Shin JY. Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer. J Korean Surg Soc 2012; 82 (03) 165-171
• 21 Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery?. Colorectal Dis 2016; 18 (01) 19-36
• 22 Motson RW, Whiteford MH, Hompes R, Albert M, Miles WF. ; Expert Group. Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference. Colorectal Dis 2016; 18 (01) 13-18
• 23 Wolthuis AM, Bislenghi G, de Buck van Overstraeten A, D'Hoore A. Transanal total mesorectal excision: towards standardization of technique. World J Gastroenterol 2015; 21 (44) 12686-12695
• 24 Ferko A, Malý O, Örhalmi J, Dolejš J. CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc 2016; 30 (03) 1164-1171
• 25 National Institute for Health and Care Excellence. Transanal total mesorectal excision of the rectum. Interventional Procedure Guidance. March 2015. Available at: nice.org.uk/guidance/ipg514
• 26 Penna M, Hompes R, Mackenzie H, Carter F, Francis NK. First international training and assessment consensus workshop on transanal total mesorectal excision (taTME). Tech Coloproctol 2016; 20 (06) 343-352
• 27 McLemore EC, Harnsberger CR, Broderick RC. Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway. Surg Endosc 2016; 30 (09) 4130-4135
• 28 Hompes R, Arnold S, Warusavitarne J. Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis 2014; 16 (07) 498-501
• 29 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 (03) 226-230 , discussion 231
• 30 Nicholson G, Knol J, Houben B, Cunningham C, Ashraf S, Hompes R. Optimal dissection for transanal total mesorectal excision using modified CO2 insufflation and smoke extraction. Colorectal Dis 2015; 17 (11) O265-O267
• 31 Penna M, Knol JJ, Tuynman JB, Tekkis PP, Mortensen NJ, Hompes R. Four anastomotic techniques following transanal total mesorectal excision (TaTME). Tech Coloproctol 2016; 20 (03) 185-191
• 32 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 (04) 221-229
• 33 Bracey E, Knol J, Buchs N. , et al. Technique for a stapled anastomosis following transanal total mesorectal excision for rectal cancer. Colorectal Dis 2015; 17 (10) O208-O212
• 34 Atallah S, Nassif G, Polavarapu H. , et al. Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol 2013; 17 (04) 441-447
• 35 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 (04) 423-426
• 36 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 (01) 145-153
• 37 Atallah S, Nassif G, Larach S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc 2015; 29 (01) 207-211
• 38 Buchs NC, Hompes R. Stereotactic navigation and augmented reality for transanal total mesorectal excision?. Colorectal Dis 2015; 17 (09) 825-827
• 39 Deijen CL, Velthuis S, Tsai A. , et al. COLOR III: a multicentre randomized clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 2016; 30 (08) 3210-3215