Transanal Total Mesorectal Excision for Rectal Cancer: Perioperative and Oncological Outcomes

摘要

Over decades, the total mesorectal excision (TME) has becomethe standard technique for rectal cancer surgery [1]. Recently,through advances in technology and surgical technique, the TMEhas been performed by using laparoscopic and robotic techniquesrather than an open technique. Recent randomized clinical trialscomparing a laparoscopic TME with an open TME have shownbetter short-term outcomes for the laparoscopic TME, as well asoncological outcomes similar to those achieved using an openTME [2-5]. Compared to laparoscopic TMEs, robotic TMEs havenot yet shown any superiority in perioperative and long-term oncologicaloutcomes [6]. Despite the advantage of using a minimallyinvasive technique, some conditions, including a narrowpelvis, a high body mass index (BMI), and bulky tumors, are obstaclesfor ontologically safe surgery with a negative resectionmargin [7-9]. The concept of a transanal TME (taTME) has beenproposed as an alternative technique to a laparoscopic and a roboticTME to overcome these practical problems in difficult cases.Since the first taTME resection for rectal cancer by using the laparoscopictechnique was reported in 2010 [10], the taTME hasshown promising results with regard to pathological quality andshort- and mid-term outcomes [11-13]. However, the oncologicaloutcomes of taTMEs, compared to.