Transanal approach for rectal tumors: recent updates and future perspectives

Abstract

Local excision of rectal tumors has long been performed. With the development of new technologies for endoluminal operation, there have been significant advances in the transanal approach in the last 30 years. It started with conventional transanal excision (TAE) and was developed by introduction of transanal total mesorectal excision (taTME). Appropriate patient selection for transanal approaches is the key for good outcomes. TAE of rectal tumors has been advocated for premalignant lesions and used as definitive treatment for early rectal cancers in select groups without adverse prognostic features. Regardless of procedures, the morbidity and mortality of tansanal technique are lower than for radical surgery. According to the experience in the last decades, transanal endoscopic surgery has been accepted as effective treatments in selected patients with early rectal cancer, with similar oncologic outcomes to and better functional effects than those of radical surgery. The latest development in transanal approaches is taTME. Although taTME is another new technique with great promise, the supporting data are preliminary, and further studies with larger cohorts of patients are needed to evaluate long term functional and oncological outcomes. Transanal approaches have enabled mid and upper rectal lesion and sphincter salvage, leading to a better quality of life. transanal approaches including taTME should be considered as good options for the treatment of rectal cancer because these techniques are definitely useful in selected patients.