title: Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results.
abstract: BACKGROUND
  Laparoscopic trans-abdominal total mesorectal excision is technically demanding. Transanal Total Mesorectal Excision (taTME) is a new technique which seems to provide technical advantages. This study describes the results of taTME in a consecutive series of patients with low rectal cancer.
  
  
  METHODS
  From January 2012 to December 2013, a consecutive series of 26 patients with low rectal cancer underwent laparoscopic taTME with coloanal anastomosis. cT4 or Type II-III rectal cancer (according to Rullier's classification) were contraindications to taTME. After anal sleeve mucosectomy, the rectal wall was transected at the ano-rectal junction. A single-access multichannel port was inserted in the anal canal. taTME was performed from down to up until the sacral promontory posteriorly and the Pouch of Douglas anteriorly were reached. A laparoscopic trans-abdominal approach was used to complete the left colon mobilization.
  
  
  RESULTS
  Sixteen patients (61.5%) were male. The mean distance of the rectal cancer from the anal verge was 4.4 cm (range 3-6). Nineteen patients (73.1%) received long-course neoadjuvant radiotherapy. At final pathology, resection margins were negative in all the patients: the mean distal and radial resection margins were 19 mm and 11.2 mm, respectively. TME was complete in 23 patients (88.5%) and nearly complete in three. Postoperative mortality was 3.8%. The overall morbidity rate was 26.9% (7 patients): two patients (7.7%) had an anastomotic leakage (Dindo I-d). After a mean follow up of 23 months, no patients have developed a local recurrence.
  
  
  CONCLUSIONS
  laparoscopic taTME allow wide resection margins and good quality TME.
authors: Department of Surgical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, TO, Italy. Electronic address: andrea.muratore@ircc.it.
authors: A
authors: A
authors: Muratore
authors: Department of Surgical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, TO, Italy.
authors: A
authors: A
authors: Mellano
authors: Department of Surgical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, TO, Italy.
authors: P
authors: P
authors: Marsanic
authors: Department of Surgical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, TO, Italy.
authors: M
authors: M
authors: De Simone
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D003106:Colon / Q000601:surgery*; D018572:Disease-Free Survival; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D016055:Urinary Retention / Q000209:etiology
keywords: Laparoscopy; Rectal cancer; TME; Transanal approach