Laparoscopic anterior resection with transanal total mesorectal excision for rectal cancer: preliminary experience and impact on postoperative bowel function.
OBJECTIVE
Transanal total mesorectal excision (TME) and the "down-to-up" mobilization concept might be possible alternatives to the standard TME, particularly in cases of narrow pelvis or bulky tumors in obese patients. Our aim was to test the feasibility and safety of transanal TME and to evaluate its impact on short-term functional outcome.


METHODS
Six consecutive patients with histologically proven low/middle rectal adenocarcinoma were prospectively enrolled. All patients underwent laparoscopic anterior resection with transanal TME. Intraoperative complications, postoperative morbidity, and oncologic adequacy of the surgical specimen were evaluated in all patients. A bowel function questionnaire using information from the Wexner's score continence grading scale was administered to all patients 1 week before surgery and 6 months following operation.


RESULTS
Laparoscopically assisted transanal TME was successful in all patients. Mean operative time was 236 minutes (range, 200-270 minutes). There were no intraoperative complications. The anastomotic leak rate was 16.6%. Clear distal and circumferential margins and proper lymphadenectomy were obtained in all surgical specimens (mean number of nodes harvested, 32; range, 19-68). In no patients was a major incontinence observed; the median (range) Wexner score at 6 months after surgery was 3 (1-7).


CONCLUSIONS
Transanal TME is safe and feasible. Preliminary outcomes meet oncologic criteria. Moreover, the transanal approach does not have an adverse impact on functional outcome. Further long-term evaluation of results and clinical trials should be performed.
1 Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita Salute , Milan, Italy .
Ugo
U
Elmore
Uberto
U
Fumagalli Romario
Andrea
A
Vignali
Matias F
MF
Sosa
Maria Rachele
MR
Angiolini
Riccardo
R
Rosati
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*