Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature.
OBJECTIVE
The present study aimed to compare the operative and oncologic results of transanal total mesorectum excision (Ta-TME) ("down-to-up") vs. laparoscopic TME (L-TME, "up-to-down") for low rectal cancer. Additionally, a systematic review of the literature was performed to assess the quality of the current body of evidence on Ta-TME.


METHODS
The study population included 32 consecutive patients who underwent Ta-TME between January 2011 and December 2014 that were compared with a matched group of patients undergoing L-TME between January 2008 and December 2010. The literature search was performed following the PRISMA guidelines for a systematic review.


RESULTS
Ta-TME was associated with significantly shorter operative time (195 vs. 225 min; p = 0.017) and hospital stay (7.8 vs. 9.7 days; p = 0.018) compared to L-TME. No group differences were observed for intra-/postoperative complications and oncologic outcomes. One patient in the Ta-TME and two patients in the L-TME group developed local recurrence. The estimated survival rate at 2 years was 95.5 % for the Ta-TME and 96.6 % for the L-TME group (p = 0.646). The literature search identified 22 relevant retrospective studies on 423 patients operated on Ta-TME or robotic-assisted transanal TME for rectal cancer. The only two comparative studies found similar short-term oncologic outcomes between Ta-TME and L-TME. A complete mesorectum was observed in 85 % of Ta-TME cases. The conversion rate was estimated at 4.3 % and the postoperative complication rate at 30.4 %.


CONCLUSIONS
Ta-TME appears to be safe and feasible. It may find special application in patients with anatomic constraints that could make L-TME highly challenging.
Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. nic.deangelis@yahoo.it.
Nicola
N
de'Angelis
General Surgery Department, University of Eastern Piedmont, A. O. U. "Maggiore della Carità" Hospital, Novara, Italy.
Luca
L
Portigliotti
Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Daniel
D
Azoulay
Unit of Digestive Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Francesco
F
Brunetti
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
Laparoscopy; Rectal cancer; Total mesorectal excision; Transanal minimally invasive surgery for total mesorectal excision