Published online Mar 27, 2018. doi: 10.4240/wjgs.v10.i3.28
Peer-review started: November 22, 2017
First decision: December 21, 2017
Revised: January 30, 2018
Accepted: February 9, 2018
Article in press: February 9, 2018
Published online: March 27, 2018
Processing time: 121 Days and 16.6 Hours
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision (TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life (QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision (TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending. As evidence for safety and feasibility accumulates, structured training programs to standardize teaching, training, and safe expansion will aid the safe spread of the TaTME.
Core tip: The evaluation and management of rectal cancer have evolved remarkably over the last few decades. Total mesorectal excision (TME) has been recognized as the standard surgical management for curative radical treatment of rectal cancer. While abdominal procedures, whether by the open or minimally invasive approaches, apply the classical concept of “top-to-bottom” dissection, the transanal TME (TaTME) uses the opposite approach of “bottom-to-top” dissection. In this review we discuss the evolution of TME for rectal cancer to the TaTME, its technical aspects, advantages, shortcomings, and current needs. The research and education initiatives as well as future directions of TaTME were also highlighted.