Research progress of transanal total mesorectal excision_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xuanhua , TIAN Yunhong , HUANG Bin ,  REN Mingyang

Department of Gastrointestinal Surgery, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

REN Mingyang, Email: 2861746489@qq.com

Keywords：

transanal total mesorectal excision; rectal cancer; oncological outcome; functional outcome; review

DOI：

10.7507/1007-9424.201702058

Video：

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Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.

Citation： YANG Xuanhua, TIAN Yunhong, HUANG Bin, REN Mingyang. Research progress of transanal total mesorectal excision. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1408-1413. doi: 10.7507/1007-9424.201702058 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
3.	Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol, 2014, 15(7): 767-774.
4.	van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218.
5.	Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med, 2015, 372(14): 1324-1332.
6.	Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA, 2015, 314(13): 1346-1355.
7.	Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA, 2015, 314(13): 1356-1363.
8.	Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol, 2016, 20(7): 483-494.
9.	Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments. Leber Magen Darm, 1983, 13(2): 73-77.
10.	Marks JH, Frenkel JL, D'Andrea AP, et al. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am, 2011, 20(3): 501-520.
11.	Atallah S, Martin-Perez B, Keller D, et al. Natural-orifice transluminal endoscopic surgery. Br J Surg, 2015, 102(2): e73-e92.
12.	Quaresima S, Balla A, Franceschilli L, et al. Transanal Minimally Invasive Surgery for Rectal Lesions. JSLS, 2016, 20(3): e2016.
13.	Whiteford MH, Denk PM, Swanström LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc, 2007, 21(10): 1870-1874.
14.	Sylla P, Willingham FF, Sohn DK, et al. NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg, 2008, 12(10): 1717-1723.
15.	Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc, 2010, 24(5): 1205-1210.
16.	Gaujoux S, Bretagnol F, Au J, et al. Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis, 2011, 13(9): e305-e307.
17.	Zhang H, Zhang YS, Jin XW, et al. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol, 2013, 17(1): 117-123.
18.	Penna M, Hompes R, Arnold S, et al. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg, 2017, 266(1): 111-117.
19.	Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet, 1986, 2(8514): 996-999.
20.	Deijen CL, Tsai A, Koedam TW, et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol, 2016, 20(12): 811-824.
21.	Lelong B, Meillat H, Zemmour C, et al. Short- and Mid-Term Outcomes after Endoscopic Transanal or Laparoscopic Transabdominal Total Mesorectal Excision for Low Rectal Cancer: A Single Institutional Case-Control Study. J Am Coll Surg, 2017, 224(5): 917-925.
22.	Xu W, Xu Z, Cheng H, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis. Eur J Surg Oncol, 2016, 42(12): 1841-1850.
23.	Buchs NC, Ostermann S, Hauser J, et al. Intestinal obstruction following use of laparoscopic barbed suture: a new complication with new material? Minim Invasive Ther Allied Technol, 2012, 21(5): 369-371.
24.	Adamsen S, Hansen OH, Funch-Jensen P, et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg, 1997, 184(6): 571-578.
25.	Velthuis S, Veltcamp Helbach M, Tuynman JB, et al. Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc, 2015, 29(11): 3319-3323.
26.	Sylla P, Bordeianou LG, Berger D, et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc, 2013, 27(9): 3396-3405.
27.	Denost Q, Adam JP, Rullier A, et al. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg, 2014, 260(6): 993-999.
28.	Rouanet P, Mourregot A, Azar CC, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum, 2013, 56(4): 408-415.
29.	Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol, 2015, 19(2): 57-61. [PMID: 25560966].
30.	Buchs NC, Wynn G, Austin R, et al. A two-centre experience of transanal total mesorectal excision. Colorectal Dis, 2016, 18(12): 1154-1161.
31.	Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg, 2015, 261(2): 228-233.
32.	Lacy AM, Tasende MM, Delgado S, et al. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg, 2015, 221(2): 415-423.
33.	Meillat H, de Chaisemartin C, Poizat F, et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol, 2017, 21(1): 43-51.
34.	Hompes R, Ashraf SQ, Gosselink MP, et al. Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Colorectal Dis, 2015, 17(2): O54-O61.
35.	Atallah S, Martin-Perez B, Albert M, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol, 2014, 18(5): 473-480.
36.	Andersson J, Abis G, Gellerstedt M, et al. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg, 2014, 101(10): 1272-1279.
37.	叶志伟, 陈远光, 胡明, 等. 直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究. 中国普通外科杂志, 2015, 24(4): 473-477.
38.	Pontallier A, Denost Q, Van Geluwe B, et al. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc, 2016, 30(11): 4924-4933.
39.	Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg, 2015, 261(2): 234-236.
40.	Hompes R, Arnold S, Warusavitarne J. Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis, 2014, 16(7): 498-501.
41.	Bislenghi G, Wolthuis AM, de Buck van Overstraeten A, et al. AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol, 2015, 19(1): 43-45.
42.	Buchs NC, Hompes R. Stereotactic navigation and augmented reality for transanal total mesorectal excision? Colorectal Dis, 2015, 17(9): 825-827.
43.	Atallah S, Nassif G, Larach S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc, 2015, 29(1): 207-211.
44.	Leroy J, Barry BD, Melani A, et al. No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg, 2013, 148(3): 226-230.
45.	Chouillard E, Regnier A, Vitte RL, et al. Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved? Tech Coloproctol, 2016, 20(8): 537-544.
46.	Atallah S, Albert M, DeBeche-Adams T, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol, 2013, 17(3): 321-325.
47.	Motson RW, Whiteford MH, Hompes R, et al. Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference. Colorectal Dis, 2016, 18(1): 13-18.
48.	Al Furajii H, Kennedy N, Cahill RA. Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy. J Minim Access Surg, 2017, 13(1): 7-12.
49.	康亮, 罗双灵, 陈文豪, 等. 经肛门全直肠系膜切除术的学习曲线. 中华胃肠外科杂志, 2016, 19(8): 917-922.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
3. Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol, 2014, 15(7): 767-774.
4. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218.
5. Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med, 2015, 372(14): 1324-1332.
6. Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA, 2015, 314(13): 1346-1355.
7. Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA, 2015, 314(13): 1356-1363.
8. Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol, 2016, 20(7): 483-494.
9. Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments. Leber Magen Darm, 1983, 13(2): 73-77.
10. Marks JH, Frenkel JL, D'Andrea AP, et al. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am, 2011, 20(3): 501-520.
11. Atallah S, Martin-Perez B, Keller D, et al. Natural-orifice transluminal endoscopic surgery. Br J Surg, 2015, 102(2): e73-e92.
12. Quaresima S, Balla A, Franceschilli L, et al. Transanal Minimally Invasive Surgery for Rectal Lesions. JSLS, 2016, 20(3): e2016.
13. Whiteford MH, Denk PM, Swanström LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc, 2007, 21(10): 1870-1874.
14. Sylla P, Willingham FF, Sohn DK, et al. NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg, 2008, 12(10): 1717-1723.
15. Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc, 2010, 24(5): 1205-1210.
16. Gaujoux S, Bretagnol F, Au J, et al. Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis, 2011, 13(9): e305-e307.
17. Zhang H, Zhang YS, Jin XW, et al. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol, 2013, 17(1): 117-123.
18. Penna M, Hompes R, Arnold S, et al. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg, 2017, 266(1): 111-117.
19. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet, 1986, 2(8514): 996-999.
20. Deijen CL, Tsai A, Koedam TW, et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol, 2016, 20(12): 811-824.
21. Lelong B, Meillat H, Zemmour C, et al. Short- and Mid-Term Outcomes after Endoscopic Transanal or Laparoscopic Transabdominal Total Mesorectal Excision for Low Rectal Cancer: A Single Institutional Case-Control Study. J Am Coll Surg, 2017, 224(5): 917-925.
22. Xu W, Xu Z, Cheng H, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis. Eur J Surg Oncol, 2016, 42(12): 1841-1850.
23. Buchs NC, Ostermann S, Hauser J, et al. Intestinal obstruction following use of laparoscopic barbed suture: a new complication with new material? Minim Invasive Ther Allied Technol, 2012, 21(5): 369-371.
24. Adamsen S, Hansen OH, Funch-Jensen P, et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg, 1997, 184(6): 571-578.
25. Velthuis S, Veltcamp Helbach M, Tuynman JB, et al. Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc, 2015, 29(11): 3319-3323.
26. Sylla P, Bordeianou LG, Berger D, et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc, 2013, 27(9): 3396-3405.
27. Denost Q, Adam JP, Rullier A, et al. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg, 2014, 260(6): 993-999.
28. Rouanet P, Mourregot A, Azar CC, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum, 2013, 56(4): 408-415.
29. Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol, 2015, 19(2): 57-61. [PMID: 25560966].
30. Buchs NC, Wynn G, Austin R, et al. A two-centre experience of transanal total mesorectal excision. Colorectal Dis, 2016, 18(12): 1154-1161.
31. Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg, 2015, 261(2): 228-233.
32. Lacy AM, Tasende MM, Delgado S, et al. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg, 2015, 221(2): 415-423.
33. Meillat H, de Chaisemartin C, Poizat F, et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol, 2017, 21(1): 43-51.
34. Hompes R, Ashraf SQ, Gosselink MP, et al. Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Colorectal Dis, 2015, 17(2): O54-O61.
35. Atallah S, Martin-Perez B, Albert M, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol, 2014, 18(5): 473-480.
36. Andersson J, Abis G, Gellerstedt M, et al. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg, 2014, 101(10): 1272-1279.
37. 叶志伟, 陈远光, 胡明, 等. 直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究. 中国普通外科杂志, 2015, 24(4): 473-477.
38. Pontallier A, Denost Q, Van Geluwe B, et al. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc, 2016, 30(11): 4924-4933.
39. Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg, 2015, 261(2): 234-236.
40. Hompes R, Arnold S, Warusavitarne J. Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis, 2014, 16(7): 498-501.
41. Bislenghi G, Wolthuis AM, de Buck van Overstraeten A, et al. AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol, 2015, 19(1): 43-45.
42. Buchs NC, Hompes R. Stereotactic navigation and augmented reality for transanal total mesorectal excision? Colorectal Dis, 2015, 17(9): 825-827.
43. Atallah S, Nassif G, Larach S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc, 2015, 29(1): 207-211.
44. Leroy J, Barry BD, Melani A, et al. No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg, 2013, 148(3): 226-230.
45. Chouillard E, Regnier A, Vitte RL, et al. Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved? Tech Coloproctol, 2016, 20(8): 537-544.
46. Atallah S, Albert M, DeBeche-Adams T, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol, 2013, 17(3): 321-325.
47. Motson RW, Whiteford MH, Hompes R, et al. Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference. Colorectal Dis, 2016, 18(1): 13-18.
48. Al Furajii H, Kennedy N, Cahill RA. Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy. J Minim Access Surg, 2017, 13(1): 7-12.
49. 康亮, 罗双灵, 陈文豪, 等. 经肛门全直肠系膜切除术的学习曲线. 中华胃肠外科杂志, 2016, 19(8): 917-922.

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Research progress of transanal total mesorectal excision

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