Transanal TME Video Quality on YouTube Versus WebSurg and the Development of a Procedure-Specific TaTME StepScore: A Cross-Sectional Validation Study.

Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME). Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival. A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival. In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.

Transanal total mesorectal excision (TaTME) is the most recent approach developed to improve pelvic dissection in surgery for mid and low rectal tumors. There are still inconsistencies regarding the technique's oncological results. The aim of this study was to analyze clinical and oncological outcomes of the learning curve of TaTME in comparison to laparoscopic TME (lapTME). Rectal cancer patients who had TaTME and lapTME in two Portuguese colorectal units between March 2016 and December 2018 were eligible. Primary endpoints were 5-year overall survival, disease-free survival, and local recurrence. Secondary endpoints were clinical and pathological outcomes. Forty-four patients underwent TaTME (29 men) and 39 lapTME (27 men) with a median age of 69 and 66 (p = 0.093), respectively. No differences were observed concerning baseline characteristics, emphasizing their comparability. In the TaTME group, there were more hand-sewn anastomosis (0 lapTME versus 7 TaTME, p = 0.018) with significantly less distance to the dentate line (40mm lapTME versus 20mm TaTME, p = 0.005) and significantly more loop ileostomies performed (28 lapTME versus 41 TaTME, p = 0.001). There were no differences in post-operative mortality, morbidity, readmissions, and stoma closure. Groups were similar in relation to specimen quality, margins, and resectability; however, TaTME had a significantly higher node yield (14 lapTME versus 20 TaTME, p = 0.002). Finally, no disparities were noted in oncological outcomes, namely local and distant recurrence, 5-year overall survival, and disease-free survival. Even with the disadvantage of the learning curve of a new technique, TaTME appears to be comparable to lapTME, with similar long-term oncological outcomes. It has, however, a demanding learning curve, significant risk for morbidity and should be used only for selected patients.

Previous studies have demonstrated the advantages of short-term histopathological outcomes and complications associated with transanal total mesorectal excision (TME) compared with laparoscopic TME. However, the long-term oncological outcomes of transanal TME remain ambiguous. This study aims to compare 3-year disease-free survival of transanal TME with laparoscopic TME. To evaluate 3-year disease-free survival between transanal TME and laparoscopic TME in patients with rectal cancer. This randomized, open-label, noninferiority, phase 3 clinical trial was performed in 16 different centers in China. Between April 2016 and June 2021, a total of 1115 patients with clinical stage I to III mid-low rectal cancer were enrolled. The last date of participant follow-up was in June 2024. Participants were randomly assigned in a 1:1 ratio before their surgical procedure to undergo either transanal TME (n = 558) or laparoscopic TME (n = 557). The primary end point was 3-year disease-free survival, with a noninferiority margin of -10% for the comparison between transanal TME and laparoscopic TME. Secondary outcomes included 3-year overall survival and 3-year local recurrence. In the primary analysis set, the median patient age was 60 years. A total of 692 male and 397 female patients were included in the analysis. Three-year disease-free survival was 82.1% (97.5% CI, 78.4%-85.8%) for the transanal TME group and 79.4% (97.5% CI, 75.6%-83.4%) for the laparoscopic TME group, with a difference of 2.7% (97.5% CI, -3.0% to 8.1%). The lower tail of a 2-tailed 97.5% CI for the group difference in 3-year disease-free survival was above the noninferiority margin of -10 percentage points. Furthermore, the 3-year local recurrence was 3.6% (95% CI, 2.0%-5.1%) for transanal TME and 4.4% (95% CI, 2.6%-6.1%) for laparoscopic TME. Three-year overall survival was 92.6% (95% CI, 90.4%-94.8%) for transanal TME and 90.7% (95% CI, 88.3%-93.2%) for laparoscopic TME. In patients with mid-low rectal cancer, 3-year disease-free survival for transanal TME was noninferior to that of laparoscopic TME. ClinicalTrials.gov Identifier: NCT02966483.

BackgroundColorectal cancer is a common malignancy. Despite advances in minimally invasive surgery, achieving optimal outcomes for locally advanced rectal cancer remains challenging. Transanal total mesorectal excision (TaTME) is an alternative to laparoscopic total mesorectal excision (LapTME), but inconsistent data warrant a comprehensive meta-analysis of the two procedures.MethodsA systematic search was conducted across the PubMed, Embase, and Cochrane Library databases up to June 2025 using keywords related to rectal cancer and TaTME. The study protocol was registered with PROSPERO. Inclusion criteria followed the PICOS framework, selecting randomized clinical trials (RCTs) and observational studies comparing TaTME with LapTME or robotic total mesorectal excision (TME). Studies reporting on non-malignant cases, single-arm studies, and studies with insufficient data for analysis were excluded. Primary outcomes of interest were surgical metrics (operative time, conversion rates), pathological outcomes (circumferential resection margin (CRM), TME completion), oncological outcomes (local recurrence, overall survival), and functional outcomes (major low anterior resection syndrome (LARS)).ResultsIn all, 65 studies involving 13 972 participants met the inclusion criteria. TaTME had lower conversion rates (odds ratio (OR) 0.35; 95% c.i. 0.24 to 0.51; P < 0.01), improved TME completeness (OR 1.26; 95% c.i. 1.02 to 1.55; P = 0.03), and lower CRM positivity (OR 0.7; 95% c.i. 0.58 to 0.85; P < 0.01) compared with LapTME. Local recurrence was reduced (OR 0.69; 95% c.i. 0.55 to 0.87; P < 0.01) and overall survival improved (hazard ratio 0.80; 95% c.i. 0.70 to 0.91; P < 0.01) following TaTME, but TaTME was associated with a higher risk of major LARS (OR 1.58; 95% c.i. 1.11 to 2.24; P = 0.01). Subgroup analysis revealed consistent results across RCTs and cohort studies.ConclusionTaTME offers several advantages over LapTME, including lower conversion rates and improved CRM and oncological outcomes. The increased risk of major LARS with TaTME underscores the importance of balancing functional outcomes with other benefits. Future research should focus on optimizing functional recovery and addressing high heterogeneity across studies.

To compare the quality of surgical resection of transanal total mesorectal excision (TA-TME) and robotic total mesorectal excision (R-TME). Both TA-TME and R-TME have been advocated to improve the quality of surgery for rectal cancer below 10 cm from the anal verge, but there are little data comparing TA-TME and R-TME. Data of patients undergoing TA-TME or R-TME for rectal cancer below 10 cm from the anal verge and a sphincter-saving procedure from 5 high-volume rectal cancer referral centers between 2011 and 2017 were obtained. Coarsened exact matching was used to create balanced cohorts of TA-TME and R-TME. The main outcome was the incidence of poor-quality surgical resection, defined as a composite measure including incomplete quality of TME, or positive circumferential resection margin (CRM) or distal resection margin (DRM). Out of a total of 730 patients (277 TA-TME, 453 R-TME), matched groups of 226 TA-TME and 370 R-TME patients were created. These groups were well-balanced. The mean tumor height from the anal verge was 5.6 cm (SD 2.5), and 70% received preoperative radiotherapy. The incidence of poor-quality resection was similar in both groups (TA-TME 6.9% vs R-TME 6.8%; P = 0.954). There were no differences in TME specimen quality (complete or near-complete TA-TME 99.1% vs R-TME 99.2%; P = 0.923) and CRM (5.6% vs 6.0%; P = 0.839). DRM involvement may be higher after TA-TME (1.8% vs 0.3%; P = 0.051). High-quality TME for patients with rectal adenocarcinoma of the mid and low rectum can be equally achieved by transanal or robotic approaches in skilled hands, but attention should be paid to the distal margin.

Objective To explore the effect of transanal total mesorectal excision (TaTME) structured training on the operation of frozen cadaver specimens in mainland China. Methods The retrospective cross-sectional study was conducted. The data of 9 trainees who participated in the 1st TaTME structured training between April 12 and 13, 2018 were collected. Chinese Society of Colorectal Surgery, Chinese Society of TaTME Surgeons and Beijing Anatomy Society were the host of TaTME structured training, Beijing Friendship Hospital of Capital Medical University and Clinical Applied Anatomy Science and Technology Training Center of Beijing Society for Anatomy Society were the undertakers. The courses included theoretical teaching, operation demonstration and frozen cadaveric specimens operation. Nine trainees were allocated into the 3 groups, including trainees A, C, E in group 1, trainees B, D, F in group 2 and trainees G, H, I in group 3. The special questionnaire survey was carried out on all the trainees at 3 months after the end of the training, contents included the number and proficiency of TaTME before and after training, reasons for not performing TaTME, learning curve of TaTME, TaTME-related complications and adverse reactions, whether or not to continue TaTME in future, effects of training, whether or not necessary to take training before TaTME. Observation indicators: (1) situations of trainees taking part in theoretical lectures and operation demonstration; (2) situations of trainees taking part in frozen cadaveric specimens operation; (3) questionnaire survey situations of trainees at 3 months after training. Comparison of trainees before and after training was done by the rank-sum test. Results (1) Situations of trainees taking part in theoretical lectures and operation demonstration: 9 trainees received theoretical lectures and operation demonstration. The theoretical lectures helped deepen understanding of the TaTME, and operation demonstration gave an intuitive feel of technical points and considerations for TaTME. (2) Situations of trainees taking part in frozen cadaveric specimens operation: 9 trainees performed successfully frozen cadaveric specimens operation under the guidance of the instructors to achieve training purposes. Overall evaluation of the instructors: anastomotic stoma was intact in 3 groups; grading 2 of Quirke grading of mesorectum was detected in group 1 and 2, and grading 3 in group 3; the main difficulty of complications was incorrect interstice operation and poor smog control, and urethral injury occurred in group 3. (3) Questionnaire survey situations of trainees at 3 months after training: 2, 2, 2 and 3 trainees after training carried respectively on more than 10, 6-10, 1 and 0 times TaTME, 2, 2, 1 and 4 trainees before training carried respectively on 6-10, 2-5, 1 and 0 in number of TaTME before and after training, with no statistically significant difference (Z=1.000, P>0.05). Three trainees didn′t perform TaTME due to no suitable patient, no equipment for TaTME and incompletely master operating of TaTME. After training, 1 trainee was very proficient for TaTME, 3, 3 and 2 trainees respectively needed to 1/4, 1/2 and 3/4 of guidance; before training, 1, 4 and 3 trainees needed to respectively 1/4 , 1/2 and 3/4 of guidance, and 3 trainees were very inaptitude for TaTME, with no statistically significant difference in proficiency of TaTME before and after training (Z=1.243, P>0.05). Five of 9 trainees thought that finishing learning curve needed 10 times TaTME. TaTME-related complications and adverse reactions included urethral injury, bleeding, incorrect interstice operation and incomplete specimens. Eight of 9 trainees expressed that would continue to carry on TaTME. All trainees thought TaTME structured training was very necessary and training should be finished before TaTME. Conclusions The TaTME structured training program on the operation of frozen cadaver specimens is a new attempt. The structured and standardized TaTME training is a necessary condition for clinical performing of TaTME, which is conductive to improving the safety and effectiveness of TaTME. Key words: Rectal neoplasms; Total mesorectal excision; Transanal total mesorectal excision; Structured training; Frozen cadaver specimens

Objective To explore the effect of transanal total mesorectal excision (TaTME) structured training on the operation of frozen cadaver specimens in mainland China. Methods The retrospective cross-sectional study was conducted. The data of 9 trainees who participated in the 1st TaTME structured training between April 12 and 13, 2018 were collected. Chinese Society of Colorectal Surgery, Chinese Society of TaTME Surgeons and Beijing Anatomy Society were the host of TaTME structured training, Beijing Friendship Hospital of Capital Medical University and Clinical Applied Anatomy Science and Technology Training Center of Beijing Society for Anatomy Society were the undertakers. The courses included theoretical teaching, operation demonstration and frozen cadaveric specimens operation. Nine trainees were allocated into the 3 groups, including trainees A, C, E in group 1, trainees B, D, F in group 2 and trainees G, H, I in group 3. The special questionnaire survey was carried out on all the trainees at 3 months after the end of the training, contents included the number and proficiency of TaTME before and after training, reasons for not performing TaTME, learning curve of TaTME, TaTME-related complications and adverse reactions, whether or not to continue TaTME in future, effects of training, whether or not necessary to take training before TaTME. Observation indicators: (1) situations of trainees taking part in theoretical lectures and operation demonstration; (2) situations of trainees taking part in frozen cadaveric specimens operation; (3) questionnaire survey situations of trainees at 3 months after training. Comparison of trainees before and after training was done by the rank-sum test. Results (1) Situations of trainees taking part in theoretical lectures and operation demonstration: 9 trainees received theoretical lectures and operation demonstration. The theoretical lectures helped deepen understanding of the TaTME, and operation demonstration gave an intuitive feel of technical points and considerations for TaTME. (2) Situations of trainees taking part in frozen cadaveric specimens operation: 9 trainees performed successfully frozen cadaveric specimens operation under the guidance of the instructors to achieve training purposes. Overall evaluation of the instructors: anastomotic stoma was intact in 3 groups; grading 2 of Quirke grading of mesorectum was detected in group 1 and 2, and grading 3 in group 3; the main difficulty of complications was incorrect interstice operation and poor smog control, and urethral injury occurred in group 3. (3) Questionnaire survey situations of trainees at 3 months after training: 2, 2, 2 and 3 trainees after training carried respectively on more than 10, 6-10, 1 and 0 times TaTME, 2, 2, 1 and 4 trainees before training carried respectively on 6-10, 2-5, 1 and 0 in number of TaTME before and after training, with no statistically significant difference (Z=1.000, P>0.05). Three trainees didn′t perform TaTME due to no suitable patient, no equipment for TaTME and incompletely master operating of TaTME. After training, 1 trainee was very proficient for TaTME, 3, 3 and 2 trainees respectively needed to 1/4, 1/2 and 3/4 of guidance; before training, 1, 4 and 3 trainees needed to respectively 1/4 , 1/2 and 3/4 of guidance, and 3 trainees were very inaptitude for TaTME, with no statistically significant difference in proficiency of TaTME before and after training (Z=1.243, P>0.05). Five of 9 trainees thought that finishing learning curve needed 10 times TaTME. TaTME-related complications and adverse reactions included urethral injury, bleeding, incorrect interstice operation and incomplete specimens. Eight of 9 trainees expressed that would continue to carry on TaTME. All trainees thought TaTME structured training was very necessary and training should be finished before TaTME. Conclusions The TaTME structured training program on the operation of frozen cadaver specimens is a new attempt. The structured and standardized TaTME training is a necessary condition for clinical performing of TaTME, which is conductive to improving the safety and effectiveness of TaTME. Key words: Rectal neoplasms; Total mesorectal excision; Transanal total mesorectal excision; Structured training; Frozen cadaver specimens

PurposeUnder the South Korea's unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as ‘New Health Technology,’ then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee.MethodsWe systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes.ResultsSixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11–0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures.ConclusionOur meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a ‘New Health Technology’ endorsed by NECA in South Korea.

Minimally invasive total mesorectal excision (TME) for rectal cancer can be performed via transanal TME (TaTME) or robotic TME (R-TME), yet comparative evidence in predominantly non-obese Asian cohorts remains limited. We evaluated a consecutive retrospective cohort during our institutional transition from TaTME to R-TME. Between 2016 and 2022, 109 patients with mid- or low-rectal adenocarcinoma underwent curative TaTME (n = 40) or R-TME (n = 69). The primary analysis used propensity score matching (37 pairs) based on age, sex, and tumor location. Outcomes included pathologic margins and lymph-node yield, perioperative results, and 3-year progression-free survival (PFS) and overall survival (OS). In the matched cohort, pathologic outcomes were comparable, with similar circumferential resection margin/distal margin positivity and lymph-node yield; distal margin length showed a nonsignificant trend toward being longer after TaTME (median 1.8 vs. 1.5 cm; P = 0.079). R-TME required longer operative time (median 330 vs. 251 min; P < 0.001) but was associated with less blood loss (30 vs. 90 mL; P = 0.014) and shorter hospital stay (7 vs. 8 days; P = 0.016); conversion occurred in 13.5% after TaTME versus 0% after R-TME (P = 0.054). Three-year OS and PFS did not differ between groups (log-rank P = 0.701 and P = 0.898, respectively), and results were consistent in a sensitivity analysis restricted to 2019–2020. Limitations include retrospective design, modest sample size, and temporal confounding. In this transition cohort, TaTME and R-TME achieved comparable short-term oncologic and survival outcomes; R-TME offered perioperative advantages, while TaTME showed a trend toward a longer distal margin that warrants cautious interpretation.

Laparoscopic rectal cancer surgery has several limitations. Transanal total mesorectal excision (TaTME) can potentially overcome these limitations. The aim of this study was to compare the rates of non-radical surgery and anastomotic leakage after TaTME, open TME (OpTME), laparoscopic TME (LaTME) and robotic TME (RoTME) procedures in a nationwide cohort. We extracted the demographic, perioperative and pathological data of patients who underwent a curative OpTME, LaTME, RoTME or TaTME procedure between January 2014 and December 2018 from the national database of the Danish Colorectal Cancer Group (DCCG). We conducted multiple group-comparisons, uni- and multivariate analyses to determine the factors associated with positive resection margin (+RM) and anastomotic leakage. We included 2393 patients (OpTME = 205, LaTME = 1163, RoTME = 713 and TaTME = 312). The rate of +RM was 5.7% after TaTME. The lowest rate of +RM was achieved after RoTME (8.2%, 4.7%, 2.52%, and 5.7%, after OpTME, LaTME, RoTME and TaTME respectively, p<0.001). In multivariate analysis, having a T4 tumour and intraoperative bowel perforation were associated with the risk of +RM (p<0.001, p<0.001, respectively). The factors associated with anastomotic leakage in multivariate analysis were male gender, high BMI and intraoperative bowel perforation (p<0.001, p=0.049, p=0.002, respectively). TaTME was associated with the highest rate of sphincter-saving procedures (79.8%, p<0.001), the lowest rate of bowel perforation (2.9%, p=0.028) and the lowest rate of conversion to open surgery (1.3%, p<0.001). In a nationwide audit of TME approaches, the rate of +RM was lowest after RoTME. No differences were found between the four approaches regarding the risk of anastomotic leakage. TaTME offered advantages related to sphincter-saving, perforation and conversion.

After total mesorectal excision (TME) surgery, patients with an incomplete mesorectum have an increased risk of local and overall recurrence. With the introduction of laparoscopic TME, an improved quality of the specimen was expected. However, the quality-related results were comparable to the results after traditional open surgery. Transanal TME is a new technique in which the rectum is mobilised by using a single-port and endoscopic instruments through the so called 'down to up' procedure. This new technique potentially leads to an improved specimen quality. This study was designed to investigate the pathological quality of specimens after transanal (TME) and to compare these with specimens after traditional laparoscopic TME. This matched case control study compared the specimens of a cohort of consecutive patients who underwent transanal TME with the specimens after traditional laparoscopic TME. The pathological quality of the mesorectum was determined by the definitions of Quirke as 'complete', 'nearly complete', or 'incomplete'. From June 2012 until July 2013, 25 consecutive patients underwent transanal TME because of a rectum carcinoma. Within the transanal TME group, 96% of the specimens had a complete mesorectum, while in the traditional laparoscopic group, 72% was deemed complete (p < 0.05). Other pathological characteristics, such as the circumferential resection margin, were comparable between the two groups. Transanal TME appears associated with a significant higher rate of completeness of the mesorectum. Further studies are necessary to evaluate this novel technique.

Transanal total mesorectal excision (TaTME) has been proposed as an alternative to laparoscopic total mesorectal excision (LapTME) in distal rectal tumors. Despite encouraging reports, mid- and long-term oncological results are limited. In this study, we aimed at comparing TaTME versus LapTME in patients with mid and low rectal cancer. From January 2012 to December 2019, all patients undergoing either TaTME or LapTME for rectal adenocarcinoma ≤ 12cm from the anal verge were included. Demographic, clinical, and follow-up data were retrieved from a prospective and audited database, and a propensity score-matched analysis was performed. A total of 144 patients were included, 38 underwent TaTME, and 106 LapTME. The median age was 68.0 (60.2-75.8) years, and 96 (66.7%) patients were male. Median follow-up was 30.6 (20.2-39.8) months in the TaTME group and 49.5 (22.6-68.5) months in the LapTME group. There was one (2.6%) local recurrence in the TaTME group and two (1.9%) in the LapTME group (p = 0.788). There was no difference in the 3-year disease-free survival between groups both in the primary (93% vs. 86%, p = 0.274) and the propensity score-matched analyses (93% vs. 81%, p = 0.132). Conversion to open surgery was less frequent in the TaTME group (none vs. 4 (11.4%), p = 0.041). Intra- and postoperative complications, length of stay, specimen quality, and resection margins were similar between groups. In our experience, TaTME was associated with a less frequent conversion to open surgery but otherwise had similar post-operative results compared to LapTME. Local recurrence and 3-year survival rates were similar.

Transanal total mesorectal excision (TaTME) has the potential advantages for patients with low rectal cancer. The objective of this meta-analysis was to identify the pathologic outcomes between the TaTME and laparoscopic total mesorectal excision (LaTME) in rectal cancer. The literature searches were conducted in PubMed, Cochrane Library, and EMBASE with English language restriction. The primary endpoint was circumferential margin (CRM), and the secondary endpoints were distal resection margin (DRM), mesorectal excision quality, and harvested lymph nodes. Our research identified 1090 articles, and 26 studies met the inclusion criteria for the meta-analysis. The positive CRM was lower in the TaTME than the LaTME (OR = 0.72; 95% CI = 0.53, 0.98; P = 0.04). There was no significant difference in the positive CRM between the TaTME and LaTME published after 2016 (OR = 0.80; 95% CI = 0.57, 1.12; P = 0.19), prospective study (OR = 2.70; 95% CI = 0.51, 14.24; P = 0.24), respective study (OR = 0.76; 95% CI = 0.55, 1.04; P = 0.09), BMI > 26 (OR = 1.00; 95% CI = 0.63, 1.58; P = 0.98), or sample size > 100 (OR = 0.84; 95% CI = 0.57, 1.23; P = 0.38). In addition, there was no significant difference observed between the TaTME and LaTME in terms of DRM, mesorectum incompleteness, and harvested lymph nodes. The TaTME is associated with lower positive CRM compared to the LaTME and similar pathologic outcomes including DRM, harvested lymph node, and mesorectal excision quality.

Total mesorectal excision (TME) remains the gold standard in the curative surgical treatment of rectal cancer. The principle of performing a TME, obtaining a complete and intact mesorectal envelope with a negative circumferential resection margin (CRM), is the greatest predictor of locoregional control. Technical challenges to minimally invasive techniques for proctectomy leading to high conversion rates, increased operative times, and inferior pathological outcomes have prompted the development of alternative approaches. Transanal TME (TaTME) has recently evolved in the last decade as a technique in which TME is performed utilizing a perineal approach. Precise definition of the distal resection margin, clarity of lower third and anterior rectal mobilization, and ease in obese and male patients are the proposed advantages. Following the description of transanal minimally invasive surgery (TAMIS), robotic TAMIS was soon reported. Synthesis of these techniques led to the performance of robotic TaTME. Robotic TaTME with single-port abdominal colonic mobilization via the required temporary ostomy site represents an innovative, minimally invasive technique for performing curative proctectomy for rectal cancer. This technique represents advancement in the evolution of natural orifice transluminal endoscopic surgery (NOTES) for the treatment of rectal cancer, which adheres to the principle tenants of oncologic surgery.

IntroductionThe benefit of transanal total mesorectal excision (TaTME) for mid and low rectal cancer is conflicting.AimTo assess and compare the short-term outcomes of TaTME with conventional laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer.Material and methodsWe searched PubMed, Embase and Cochrane Library databases for studies addressing TaTME versus conventional LaTME for rectal cancer between 2008 and December 2018. Randomized controlled trials (RCTs) and retrospective studies which compared TaTME with LaTME were included.ResultsTwelve retrospective case-control studies were identified, including a total of 899 patients. We did not find significant differences in overall intraoperative complications, blood loss, conversion rate, operative time, overall postoperative complication, anastomotic leakage, ileus, or urinary morbidity. Also no significant differences in oncological outcomes including circumferential resection margin (CRM), positive CRM, distal margin distance (DRM), positive DRM, quality of mesorectum, number of harvested lymph nodes, temporary stoma or local recurrence were found. Although the TaTME group had better postoperative outcomes (readmission, reoperation, length of hospital stay) on average, the difference did not reach statistical significance.ConclusionsTransanal total mesorectal excision offers a safe and feasible alternative to LaTME although the clinicopathological features were not superior to LaTME in this study. Currently, with the lack of evidence on benefits of TaTME, further evaluation of TaTME requires large randomized control trials to be conducted.