title: A two-centre experience of transanal total mesorectal excision.
abstract: OBJECTIVE
  Transanal total mesorectal excision (TaTME) offers a promising alternative to the standard surgical abdominopelvic approach for rectal cancer. The aim of this study was to report a two-centre experience of this technique, focusing on the short-term and oncological outcome.
  
  
  METHODS
  From May 2013 to May 2015, 40 selected patients with histologically proven rectal adenocarcinoma underwent TaTME in two institutions and were prospectively entered on an online international registry.
  
  
  RESULTS
  Forty patients (80% men, mean body mass index 27.4 kg/m2) requiring TME underwent TaTME. Procedures included low anterior resection (n = 31), abdominoperineal excision (n = 7) and proctocolectomy (n = 2). A minimally invasive approach was attempted in all cases, with three conversions. The mean operation time was 368 min and 16 patients (40%) had a synchronous abdominal and transanal approach. There was no mortality and 16 postoperative complications occurred, of which 68.8% were minor. The median length of stay was 7.5 (3-92) days. A complete or near-complete TME specimen was delivered in 39 (97.5%) cases with a mean number of 20 lymph nodes harvested. R0 resection was achieved in 38 (95%) patients. After a median follow-up of 10.7 months, there were no local recurrences and six (15%) patients had developed distant metastases.
  
  
  CONCLUSIONS
  TaTME appears to be feasible, safe and reproducible, without compromising the oncological principles of rectal cancer surgery. It is an attractive option for patients for whom laparoscopy is likely to be particularly difficult. These encouraging results should encourage larger studies with assessment of long-term function and the oncological outcome.
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: ICENI Centre, Colchester Hospital University Foundation Trust, Colchester, UK.
authors.forename: G
authors.initials: G
authors.lastname: Wynn
authors.affiliation: ICENI Centre, Colchester Hospital University Foundation Trust, Colchester, UK.
authors.forename: R
authors.initials: R
authors.lastname: Austin
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Penna
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.|NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Findlay
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: A L A
authors.initials: AL
authors.lastname: Bloemendaal
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Mortensen
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: O M
authors.initials: OM
authors.lastname: Jones
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Guy
authors.affiliation: Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: 
  TME
  ; Transanal; bottom up; laparoscopy; outcomes; rectal cancer; robotic