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Open AccessArticle

Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer

1
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
2
Department of Gynaecology, Christian-Albrechts-University Kiel, 24103 Kiel, Germany
3
Department of Surgery, St. John of God Hospital Graz, 8010 Graz, Austria
*
Authors to whom correspondence should be addressed.
M.B. and L.D. equally share first-authorship.
J. Clin. Med. 2021, 10(1), 72; https://doi.org/10.3390/jcm10010072
Received: 3 December 2020 / Revised: 18 December 2020 / Accepted: 23 December 2020 / Published: 28 December 2020
(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery)
Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center. Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted. Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented with a threatened CRM upon pretherapeutic MRI. Abdominal conversion rate was 5.7% with no conversion for the transanal dissection. Early anastomotic leakage occurred in 7.0% of the patients. Mesorectum specimen was complete in 87.3%, R1 resection rate was 4.5% (involved distal resection margin) and in 7.6%, the CRM was positive. The three-year local recurrence rate of 58 patients with a follow-up ≥ 36 months was 3.4%. Overall survival was 92.0% after 12 months, and 82.2% after 36 months. Conclusion: TaTME can be performed safely with acceptable long-term oncological outcome. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates. View Full-Text
Keywords: rectal cancer; mesorectal; transanal; laparoscopic; local recurrence; survival; conversion rate rectal cancer; mesorectal; transanal; laparoscopic; local recurrence; survival; conversion rate
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MDPI and ACS Style

Dittrich, L.; Biebl, M.; Schmuck, R.; Gül, S.; Weiss, S.; Haase, O.; Knoop, M.; Alkatout, I.; Pratschke, J.; Aigner, F. Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer. J. Clin. Med. 2021, 10, 72. https://doi.org/10.3390/jcm10010072

AMA Style

Dittrich L, Biebl M, Schmuck R, Gül S, Weiss S, Haase O, Knoop M, Alkatout I, Pratschke J, Aigner F. Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer. Journal of Clinical Medicine. 2021; 10(1):72. https://doi.org/10.3390/jcm10010072

Chicago/Turabian Style

Dittrich, Luca; Biebl, Matthias; Schmuck, Rosa; Gül, Safak; Weiss, Sascha; Haase, Oliver; Knoop, Michael; Alkatout, Ibrahim; Pratschke, Johann; Aigner, Felix. 2021. "Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer" J. Clin. Med. 10, no. 1: 72. https://doi.org/10.3390/jcm10010072

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