Transanal Total Mesorectal Excision for Mid and Low Rectal Cancer

Abstract

Introduction: Transanal total mesorectal excision (TaTME) was developed to overcome limitations of laparoscopic TME, particularly in narrow pelvises. This review evaluates its safety, oncologic adequacy, and learning curve compared to conventional laparoscopic TME.

Methods: A literature review was conducted including comparative studies and registry data. Outcomes were TME completeness, circumferential margin positivity, anastomotic leak, and local recurrence. Technical aspects of the “bottom-up” approach were examined.

Results: Twenty-one studies (three randomized trials) were analyzed. TaTME achieved comparable or higher rates of complete TME specimens and lower circumferential margin positivity in some series. Anastomotic leak rates were similar to laparoscopic TME. However, a concerning signal of higher local recurrence was reported in one early series, attributed to poor case selection and learning curve effects. Operative time was longer for TaTME initially.

Discussion: The transanal approach provides better visualization of the distal mesorectum, potentially reducing positive distal margins. However, the urethral injury rate (though rare) is unique to TaTME. Structured training programs and proctoring mitigate complications. The debate regarding local recurrence underscores the need for ongoing audit.

Conclusions: TaTME is a technically sound alternative to laparoscopic TME in expert hands but requires structured training. Its role should be defined by further randomized trials with long-term follow-up.