title: A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy.
abstract: BACKGROUND
  Previous publications have suggested that endoscopic transanal proctectomy (ETAP) is a promising technique and may be an alternative to conventional low anterior resection for rectal cancer. The aim of this study was to evaluate the technical feasibility of ETAP, with a particular focus on postoperative and oncological results and on functional outcomes.
  
  
  METHODS
  This study was a multicenter prospective study of unselected consecutive patients with low rectal cancer requiring proctectomy and coloanal anastomosis. All patients underwent a standardized procedure. The study endpoints were the safety and adequacy of the oncological resection criteria. All patients were evaluated with the Wexner Fecal Incontinence Questionnaire after stoma closure.
  
  
  RESULTS
  Fifty-six consecutive patients (41 men) underwent ETAP between February 2010 and June 2012. The median age was 65 years (39-83), and the median body mass index was 27 (20-42). No intraoperative complications were encountered. There was no postoperative mortality, and the morbidity rate was 26%. The mesorectum was complete in 47 cases (84%) and nearly complete in 9 cases (16%). The median number of lymph nodes retrieved was 12 (range, 7-29) per patient. The median radial and distal margins were 8 mm (0-20) and 10 mm (3-40), respectively. R0 resection was achieved in 53 patients (94.6%). The median Wexner score was 4 (3-12). Thirteen (28%) patients reported stool fragmentation and difficult evacuation.
  
  
  CONCLUSIONS
  ETAP is a feasible alternative surgical option to conventional laparoscopy for rectal resection and may represent a promising step toward rectal natural orifice transluminal endoscopic surgery (NOTES).
authors.affiliation: *Service de chirurgie digestive, Centre Hospitalier Universitaire de Rouen, 1 rue Germont 76031 Rouen Cedex, France †Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Department of Digestive and HPB Surgery, Pierre and Marie Curie University Institute of Cancerology (Paris VI), 42-83 Bd de l'hôpital, 75013 Paris, France ‡Département de Chirurgie Oncologique, institut Paoli-Calmettes, 232, Boulevard Sainte-Marguerite, 13009 Marseille, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Cécile
authors.initials: C
authors.lastname: De Chaisemartin
authors.forename: Valerie
authors.initials: V
authors.lastname: Bridoux
authors.forename: Gilles
authors.initials: G
authors.lastname: Manceau
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
authors.forename: Laurent
authors.initials: L
authors.lastname: Hanoun
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome