Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision

Abstract

The access of the low rectum is a surgical challenge and, in case of cancer, the outcome of the patient depends on the quality of the surgery. The transanal total mesorectal excision (taTME) is a surgical technique with a combined abdominal and perineal approach. We review the literature for technical aspect of taTME as well as comparisons with other techniques. Comparison with laparoscopic total mesorectal excision and taTME was summarized in a meta-analysis which showed better oncological results with lower circumferential margin involvement and better completeness of the mesorectum. TaTME is a safe approach. All steps of the intervention are well described and should be followed as numerous pitfalls exist. When compared with laparoscopic or robotic TME, the taTME showed to be safe with similar oncological results. Patients known to be difficult, male, obese, with a narrow pelvis, should be considered for the taTME approach.