Treatment of Rectal Cancer with Trans-Anal Mesorectal Excision: A Mini-Review of the Literature

Abstract

Background: The aim of this mini-review is to summarize the body of literature based on studies on the perioperative and oncological outcomes of transanal total mesorectal excision (TaTME) for the treatment of rectal cancer. Methods: A literature search of PubMED database was performed using subject headings and keywords related to rectal adenocarcinoma and transanal mesorectal excision. Results: Five case series were identified, reporting on a total of 378 patients with mean/median age ranging from 56.5 to 67.6 years and body mass index ranging from 25.2 to 27.5 kg/m2. The mean/median operative time was 166 to 270 minutes. Conversion rate to open approach ranged from 0% to 7.3% whereas postoperative complication rate ranged from 26% to 39%. The length of stay ranged from 4.5 to 10 days. The completeness of circumferential resection margin (CRM) was reported to be between 72% to 97.1%. CRM positivity ranged from 2.5% to 6.4%. The distal resection margin (DRM) ranged from 10 mm to 37.1 mm and DRM positivity ranged from 0% to 2%. The mean/median lymph node harvested ranged from 12 to 20. Short-term oncological outcome (median follow-up period of 15.1 to 29 months) was reported with local recurrence rate from 1.9% to 4% and distal recurrence rate of 3.9% to 14.5%. Conclusions: TaTME appears to be a safe technique for treatment of rectal cancer although the current evidence is limited by the heterogeneity of the quality of available studies. Randomized control trials would be necessary to assess the longterm safety and oncological outcomes of TaTME as compared to conventional rectal surgery techniques.