SpringerLink
Log in

Is transanal total mesorectal excision a reproducible and oncologically adequate technique? A pilot study in a single center

Is transanal TME a safe procedure?

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

An oncologically effective total mesorectal excision (TME) still represents a technical challenge, especially in the presence of a low rectal cancer and anatomical restraints such as obesity or narrow pelvis. Recently, few reports have shown that transanal TME was feasible and associated with good outcomes. Nevertheless, a widespread employment of the technique has yet to happen due to the doubts about the reproducibility of the results outside a tertiary specialized center.

Methods

Between February 2014 and June 2015, patients with low rectal cancer underwent a transanal TME with laparoscopic assistance. The end points included the oncologic adequacy of the mesorectal excision and the perioperative outcomes.

Results

Eleven patients (9 male, median age 70.5 years) with proven low rectal cancer were enrolled in the study. The median distance of the tumor from the anal verge was 5 cm (2–7). Four patients (36.4 %) received preoperative chemoradiation. The median operative time was 360 min (275–445). Postoperative morbidity (36.4 %) included one (9.1 %) anastomotic leak requiring a reoperation. The median length of hospital stay was 8 days (3–28). The median distance from the circumferential and distal resection margins were, respectively, 5 (1–20) and 10 (5–20) mm, and the mean number of harvested lymph nodes was 21.7 (11–50). All cases had a complete or nearly complete mesorectal plane of surgery.

Conclusions

Although technically challenging, the initial results suggest that transanal TME could be a feasible, oncologically safe, and reproducible operation. However, more robust studies are required to assess the short- and long-term outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  CAS  PubMed  Google Scholar 

  2. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  3. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711

    Article  CAS  PubMed  Google Scholar 

  4. Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma is caused by inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    Article  CAS  PubMed  Google Scholar 

  5. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645

    Article  PubMed  Google Scholar 

  6. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, Colorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:208–210

    Google Scholar 

  7. Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) 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 18:473–480

    Article  CAS  PubMed  Google Scholar 

  8. Heald RJ (2014) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258

    Article  Google Scholar 

  9. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289

    Article  CAS  PubMed  Google Scholar 

  10. Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405

    Article  PubMed  Google Scholar 

  11. Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28:3494–3499

    Article  PubMed  Google Scholar 

  12. Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E (2014) Notes total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 28:3150–3157

    Article  CAS  PubMed  Google Scholar 

  13. Ceelen W, Boterberg T, Pattyn P, van Eijkeren M, Gillardin JM, Demetter P, Smeets P, Van Damme N, Monsaert E, Peeters M (2007) Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer. Ann Surg Oncol 14:424–431

    Article  PubMed  Google Scholar 

  14. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  15. Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989

    Article  CAS  PubMed  Google Scholar 

  16. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  17. De Lacy A, Rattner DW, Adelsdorfer C, Tasende M, Fernandez M, Delgado S, Sylla P, Martinez-Palli G (2013) 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 27:3165–3172

    Article  PubMed  Google Scholar 

  18. Fernandez-H M, Delgado S, Castells A, Tasende M, Momblan D, Diaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer: short term outcomes in comparison with laparoscopic surgery. Ann Surg 261:221–227

    Article  Google Scholar 

  19. Zhang H, Zhang YS, ** XW, Li MZ, Fan JS, Yang ZH (2013) Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 17:117–123

    Article  CAS  PubMed  Google Scholar 

  20. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    Article  CAS  PubMed  Google Scholar 

  21. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373:821–828

    Article  PubMed Central  PubMed  Google Scholar 

  22. Bosch SL, Nagtegaal ID (2012) The importance of the pathologist role in assessment of the quality of the mesorectum. Curr colorectal cancer Rep 8:90–98

    Article  PubMed Central  PubMed  Google Scholar 

  23. Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82

    Article  CAS  PubMed  Google Scholar 

  24. Marks JH, Valsdottir EB, Rather AA, Nweze IC, Newman DA, Chernick MR (2010) Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum 53:1023–1029

    Article  CAS  PubMed  Google Scholar 

  25. Lee SH, Hernandez de Anda E, Finne CO, Madoff RD, Garcia-Aguilar J (2005) The effect of circumferential tumor location in clinical outcomes of rectal cancer patients treated with total mesorectal excision. Dis Colon Rectum 48:2249–2257

    Article  PubMed  Google Scholar 

  26. Wexner SD, Berho M (2014) Transanal TAMIS total mesorectal excision (TME)—a work in progress. Tech Coloproctol 18:423–425

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, University College Hospital, 235 Euston Road, NW1 2BU, London, UK

    Matteo Rottoli

  2. Department of Colorectal Surgery, Medway Maritime Hospital, Medway, UK

    Lydia Hanna, Neil Kukreja, Alok Pancholi & Henk Wegstapel

Authors
  1. Matteo Rottoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lydia Hanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil Kukreja
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alok Pancholi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henk Wegstapel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matteo Rottoli.

Ethics declarations

Conflict of interest

Drs. Rottoli, Hanna, Kukreja, Pancholi, and Wegstapel have no relevant financial interests to disclose.

Human and animal rights and informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rottoli, M., Hanna, L., Kukreja, N. et al. Is transanal total mesorectal excision a reproducible and oncologically adequate technique? A pilot study in a single center. Int J Colorectal Dis 31, 359–363 (2016). https://doi.org/10.1007/s00384-015-2418-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2418-0

Keywords

Search

Navigation