Abstract
IntroductionTransanal total mesorectal excision (taTME) is a novel approach to surgery for rectal cancer. The technique has gained significant popularity in the surgical community due to the promising ability to overcome technical difficulties related to the access of the distal pelvis. Recently, Norwegian surgeons issued a local moratorium related to potential issues with the safety of the procedure. Early adopters of taTME in Canada have recognized the need to create guidelines for its adoption and supervision. The objective of the statement is to provide expert opinion based on the best available evidence and authors’ experience.MethodsThe procedure has been performed in Canada since 2014 at different institutions. In 2016, the first Canadian taTME congress was held in the city of Toronto, organized by two of the authors. In early 2019, a multicentric collaborative was established [The Canadian taTME expert Collaboration] which aimed at ensuring safe performance and adoption of taTME in Canada. Recently surgeons from 8 major Canadian rectal cancer centers met in the city of Toronto on December 7 of 2019, to discuss and develop a position statement. There in person, meeting was followed by 4 rounds of Delphi methodology.ResultsThe generated document focused on the need to ensure a unified approach among rectal cancer surgeons across the country considering its technical complexity and potential morbidity. The position statement addressed four domains: surgical setting, surgeons’ requirements, patient selection, and quality assurance.ConclusionsAuthors agree transanal total mesorectal excision is technically demanding and has a significant risk for morbidity. As of now, there is uncertainty for some of the outcomes. We consider it is possible to safely adopt this operation and obtain adequate results, however for this purpose it is necessary to meet specific requirements in different domains.
Highlights
Transanal total mesorectal excision is a novel approach to surgery for rectal cancer
The Canadian taTME expert COllaboration (CaTaCO) working group was put together based on knowledge prior to this publication of centers considered to be high volume in managing rectal cancer patients in Can‐ ada
We understand the management of rectal cancer is multidisciplinary, and this concept is integral part of our recommendations throughout, in addition we have incorporated our recently published rectal cancer Canadian Partnership Against Cancer (CPAC) guidelines [22], which clearly delineate the multi‐ specialty approach of rectal cancer in Canada
Summary
The CaTaCO working group was put together based on knowledge prior to this publication of centers considered to be high volume in managing rectal cancer patients in Can‐ ada These centers are well-known in the Cana‐ dian context to be performing taTME consistently, and are a cohesive group of subspecialty surgeons (colorectal sur‐ gery and surgical oncology) from across the country. Current acceptable alternate pathways include a cadaveric in-person training program, usually offered to surgeons with the requisite minimum number of rectal cancer and transanal procedures performed per year. Given the potential morbidity of the procedure, taTME should be reserved for patients in whom a significant benefit could be envisioned by the operating team This could include optimizing the oncologic distal dissection, sphincter preservation or any of the other mentioned ben‐ efits above [19/19—100%]. We support performing a quality review at an institu‐ tional level of taTME outcomes vs. existing open/lapa‐ roscopic/robotic oncologic outcomes to ensure the pro‐ cedure continues to provide patient-centered benefits relative to current standards [19/19—100%]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
