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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2018; 10(3): 28-39
Published online Mar 27, 2018. doi: 10.4240/wjgs.v10.i3.28
Evolution of transanal total mesorectal excision for rectal cancer: From top to bottom
Sameh Hany Emile, F Borja de Lacy, Deborah Susan Keller, Beatriz Martin-Perez, Sadir Alrawi, Antonio M Lacy, Manish Chand
Sameh Hany Emile, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura City 35516, Egypt
F Borja de Lacy, Beatriz Martin-Perez, Antonio M Lacy, Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona 08036, Spain
Deborah Susan Keller, Manish Chand, GENIE Centre, University College London, London NW1 2BU, United Kingdom
Deborah Susan Keller, Manish Chand, Department of Surgery and Interventional Sciences, University College London Hospitals, NHS Trusts, London NW1 2BU, United Kingdom
Sadir Alrawi, Department of Surgical Oncology, Alzahra Cancer Center, Al Zahra Hospital, Dubai 3499, United Arab Emirates
Author contributions: Emile SH, de Lacy FB, Keller DS, Martin-Perez B, Alrawi S, Lacy AM and Chand M contributed to the conception and design of the study, literature review and analysis, drafting and critical revision and editing and final approval of the submitted version.
Conflict-of-interest statement: Professor Lacy is the founder and director of Advances in Surgery (AIS) channel, Dr. Lacy and Dr. Martin-Perez are members of the team operating the AIS channel, and Mr. Chand is the AIS Country Coordinator in United States. There was no association between the present work and the AIS channel. Dr. Emile and Dr. Keller have no potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Manish Chand, MBBS, FRCS, MBA, PhD, Associate Professor, Consultant Colorectal Surgeon, and Senior Lecturer, Department of Surgery and Interventional Sciences, University College London Hospitals, NHS Trusts, Charles Bell House, 43 Foley Street, London W1W 7TS, United Kingdom.
m.chand@ucl.ac.uk
Telephone: +44-20-34475879 Fax: +44-20-34479218
Received: November 21, 2017
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.
