title: A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer.
abstract: BACKGROUND
  The objective of this pilot study was to evaluate the feasibility and safety of natural orifice endoscopic transanal total mesorectal excision (TME) with laparoscopic assistance in a cohort study of five patients with stage I and IIA rectal cancer.
  
  
  METHODS
  Five eligible patients with node-negative rectal cancer located 4-12 cm from the anal verge were enrolled in an IRB-approved pilot study. All patients underwent transanal endoscopic TME with laparoscopic assistance, hand-sewn coloanal anastomosis, and a diverting loop ileostomy. Primary and secondary end points included adequacy of the mesorectal excision and 30-day postoperative complications, respectively.
  
  
  RESULTS
  Between November 2011 and May 2012, three males and two females underwent transanal endoscopic TME with laparoscopic assistance. Patient mean age and BMI were 48.6 ± 9.8 years and 25.7 ± 2.3 kg/m(2), respectively. Tumors were located an average of 5.7 ± 2.4 cm from the anal verge and preoperatively staged as T1N0M0 (2), T2N0M0 (1), and T3N0M0 (2). Mean operative time was 274.6 ± 85.4 min with no intraoperative complications. Partial intersphincteric resection was performed in conjunction with transanal endoscopic TME in three patients. Pathologic examination of TME specimens demonstrated complete mesorectal excision in all cases with negative proximal, distal, and radial margins. Mean length of hospital stay was 5.2 ± 2.6 days and three minor complications occurred, including one ileus and two cases of transient urinary dysfunction. At a mean early follow-up of 5.4 ± 2.3 months, all patients remain disease-free.
  
  
  CONCLUSIONS
  In this pilot study of five patients with rectal cancer, transanal endoscopic TME with laparoscopic assistance is feasible and safe, and is a promising alternative to open and laparoscopic TME. Evaluation of long-term functional and oncologic outcomes of this approach is needed before widespread adoption can be recommended.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA. psylla@partners.org
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Kyung S
authors.initials: KS
authors.lastname: Han
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Dushyant V
authors.initials: DV
authors.lastname: Sahani
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Sbeih
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Lacy
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
mesh_terms: D001003:Anal Canal; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome