Transanal total mesorectal excision--a systematic review.

Introduction: Total mesorectal excision (TME) is the standard surgical treatment for mid and low rectal cancer. The procedure is performed by open, laparoscopic or robotic approaches. Transanal TME (TaTME) is a new procedure that potentially solves some difficulties in the pelvic part of the dissection. We aimed to evaluate the literature on TaTME.

Methods: We performed a systematic search of the literature in the PubMed and Embase databases. Both authors assessed the studies. All publications on TaTME were included with the exception of review articles.

Results: A total of 29 studies (336 patients) were included. Only low-quality evidence is available, and the literature consists of case reports and case series. Studies represent the initial experience of surgeons/centres. No precise indication for TaTME is yet specified other than the presence of mid and low rectal tumours, although the potential advantages seem to be related to a bulky mesorectum in the male pelvis. The preliminary results are encouraging and the most serious complication is urethral injury. The oncological results are acceptable, although the follow-up is short.

Conclusion: TaTME is a feasible approach for mid and low rectal cancers. Long-term follow-up data are awaited regarding functional results, local recurrence and survival, and to facilitate comparison with standard laparoscopic or robotic rectal resections.