Clinical and Translational Research
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 12-23
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.12
Laparoscopy-assisted transanal total mesorectal excision for lower rectal cancer: A feasible and innovative technique
Ying-Jie Li, Lin Wang, Ting-Ting Sun, Ai-Wen Wu
Ying-Jie Li, Lin Wang, Ting-Ting Sun, Ai-Wen Wu, Gastrointestinal Cancer Center Unit III, Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing 100142, China
Ying-Jie Li, Ai-Wen Wu, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing 100142, China
Author contributions: Wu AW contributed to conception and design of the study, drafting and final approval of the manuscript; Li YJ and Sun TT collected the data and drafted the manuscript; Wu AW, Wang L, and Li YJ provided quality control of the study especially the surgery part, and acquired the data; Li YJ contributed to the study design and statistical analysis; All authors approved the final manuscript.
Supported by the National Natural Sciences Foundation of China, No. 81773214
Institutional review board statement: This study and the protocol were reviewed and approved by the Ethics Committee at Beijing Cancer Hospital (approval no. 2017-p2-181-01).
Clinical trial registration statement: This registration policy applies to prospective, randomized, controlled trials only.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Wen Wu, MD, PhD, Professor, Teacher, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Beijing Institute for Cancer Research, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. drwuaw@sina.com
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: September 16, 2020
Revised: September 28, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 15, 2021
Processing time: 143 Days and 6.9 Hours
ARTICLE HIGHLIGHTS
Research background

Transanal total mesorectal excision (taTME) is a new technique that might have many technical advantages. Laparoscopy-assisted taTME is also known as transabdominal taTME or hybrid-natural orifice transluminal endoscopic surgery taTME. Laparoscopy-assisted taTME is a combination of techniques, such as minimally invasive surgery, intersphincter-assisted resection, natural orifice extraction, ta minimally invasive surgery, and ultralow-level preservation of the anus.

Research motivation

Laparoscopy-assisted taTME surgery was reported by literature with relatively small amount of cases. However, there has been little published data on laparoscopy-assisted taTME surgery on the Chinese population. The safety and feasibility of laparoscopy-assisted taTME is still lack of report.

Research objectives

This study was designed to investigate the utility of laparoscopy-assisted taTME technique with both favorable and unfavorable factors.

Research methods

Laparoscopy-assisted taTME surgery was done by a standard laparoscopic platform (STARPORT Port). Patients’ characteristics, surgery duration, pathological diagnosis and postoperative complications (Clavien-Dindo classification) were collected.

Research results

Laparoscopy-assisted taTME could be safe and feasible technique to rectal tumor. Laparoscopic surgeons would be proficient for laparoscopy-assisted taTME with approximately 20 cases. Laparoscopy-assisted taTME may provide an alternative to traditional surgical methods for accurate anal retention. This study demonstrated the first piece of evidence of peri-operative data and short-term outcome in patients treated with laparoscopy-assisted taTME in Chinese tertiary hospital.

Research conclusions

Laparoscopy-assisted taTME is suitable for selected patients with lower rectal cancer, and this technique is worthy of further recommendation.

Research perspectives

At present, taTME is mainly suitable for malignant tumors requiring accurate anatomy and resection of the middle and lower rectum and mesangial. The indications of taTME for the treatment of malignant rectal tumors should be limited to low and medium rectal cancers, especially low rectal cancers. TaTME may be more advantageous for rectal cancer patients with “difficult pelvis,” such as male, prostatic hypertrophy, obesity, tumor diameter of > 4 cm, rectal mesangial hypertrophy, lower anterior rectal tumor, anterior rectal wall tumor, narrow pelvic, and unclear tissue, and unclear tissue plane caused by neoadjuvant radiotherapy. In addition, taTME can be performed in combination with sphincter resection (ISR) for ultra-low rectal cancer patients. TaTME surgery may have indications for the treatment of colorectal benign diseases: Large benign tumors of the middle and lower rectum that cannot be removed locally, inflammatory bowel disease requiring rectal excision, familial adenomatous polyposis, and radioactive proctitis.