title: Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) has always made more sense in the colorectal field where the target organ for entry houses the pathology. To address the question whether an adequate total mesorectal excision (TME) for rectal cancer can be performed from a transanal bottoms-up approach, we performed a case-matched study.
  
  
  METHODS
  Starting in 2009, transanal TME (taTME) surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database. Between March 2012 and February 2014, 17 consecutive taTME rectal cancer patients were identified and case-matched to multiport laparoscopic TME (MP TME) based on age, body mass index, uT stage, radiation dose, level in the rectum, and procedure. Perioperative outcomes, morbidity, mortality, local recurrence, completeness of TME, and radial and distal margins were analyzed. Statistically significant differences were identified using Student's t test.
  
  
  RESULTS
  There were 12 transanal abdominal transanal (TATA)/5 abdominoperineal resection procedures in each group. Data regarding overall/taTME/MP TME are as follows: % positive-circumferential margin: 2.9/0/5.9 % (p = 0.32). Distal margin: 0/0/0 %. Complete or near-complete TME: 97.1/100/94.1 % (p = 0.32). Incomplete TME 2.9/0/5.9 % (p = 0.32). Local recurrence: 2.9/5.9/0 % (p = 0.32). There were no perioperative mortalities. Morbidity in each group: 26.4/23.5/29.4 % (p = 0.79). There were no differences in perioperative or postoperative outcomes except days to clear liquids (1/2 days, p = 0.03) and largest incision length (1.3/2.6 cm, p = 0.05).
  
  
  CONCLUSIONS
  We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottoms-up TME compared to standard laparoscopic TME. TaTME is a promising progressive approach to NOTES and deserves additional evaluation.
authors.affiliation: Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA. marksj@mlhs.org.
authors.forename: J H
authors.initials: JH
authors.lastname: Marks
authors.affiliation: Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.|Division of Colorectal Surgery, Saint Louis University Hospital, Saint Louis, MO, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Montenegro
authors.affiliation: Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Salem
authors.affiliation: Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Shields
authors.affiliation: Division of Colorectal Surgery, Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects
keywords: Laparoscopic surgery; NOTES; Rectal cancer; Sphincter-preserving surgery; TAMIS; TATA; TaTME