title: Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma.
abstract: BACKGROUND
  After total mesorectal excision (TME) surgery, patients with an incomplete mesorectum have an increased risk of local and overall recurrence. With the introduction of laparoscopic TME, an improved quality of the specimen was expected. However, the quality-related results were comparable to the results after traditional open surgery. Transanal TME is a new technique in which the rectum is mobilised by using a single-port and endoscopic instruments through the so called 'down to up' procedure. This new technique potentially leads to an improved specimen quality. This study was designed to investigate the pathological quality of specimens after transanal (TME) and to compare these with specimens after traditional laparoscopic TME.
  
  
  METHODS
  This matched case control study compared the specimens of a cohort of consecutive patients who underwent transanal TME with the specimens after traditional laparoscopic TME. The pathological quality of the mesorectum was determined by the definitions of Quirke as 'complete', 'nearly complete', or 'incomplete'.
  
  
  RESULTS
  From June 2012 until July 2013, 25 consecutive patients underwent transanal TME because of a rectum carcinoma. Within the transanal TME group, 96% of the specimens had a complete mesorectum, while in the traditional laparoscopic group, 72% was deemed complete (p < 0.05). Other pathological characteristics, such as the circumferential resection margin, were comparable between the two groups.
  
  
  CONCLUSIONS
  Transanal TME appears associated with a significant higher rate of completeness of the mesorectum. Further studies are necessary to evaluate this novel technique.
authors: Department of Surgery, Gelderse Vallei Hospital, 6716 RP, Ede, The Netherlands, velthuissimone@gmail.com.
authors: Simone
authors: S
authors: Velthuis
authors: Dorothee H
authors: DH
authors: Nieuwenhuis
authors: T Emiel G
authors: TE
authors: Ruijter
authors: Miguel A
authors: MA
authors: Cuesta
authors: H Jaap
authors: HJ
authors: Bonjer
authors: Colin
authors: C
authors: Sietses
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult