Is transanal total mesorectal excision a reproducible and oncologically adequate technique? A pilot study in a single center: Is transanal TME a safe procedure?

Purpose: An oncologically effective total mesorectal excision (TME) still represents a technical challenge, especially in the presence of a low rectal cancer and anatomical restraints such as obesity or narrow pelvis. Recently, few reports have shown that transanal TME was feasible and associated with good outcomes. Nevertheless, a widespread employment of the technique has yet to happen due to the doubts about the reproducibility of the results outside a tertiary specialized center. Methods: Between February 2014 and June 2015, patients with low rectal cancer underwent a transanal TME with laparoscopic assistance. The end points included the oncologic adequacy of the mesorectal excision and the perioperative outcomes. Results: Eleven patients (9 male, median age 70.5 years) with proven low rectal cancer were enrolled in the study. The median distance of the tumor from the anal verge was 5 cm (2–7). Four patients (36.4 %) received preoperative chemoradiation. The median operative time was 360 min (275–445). Postoperative morbidity (36.4 %) included one (9.1 %) anastomotic leak requiring a reoperation. The median length of hospital stay was 8 days (3–28). The median distance from the circumferential and distal resection margins were, respectively, 5 (1–20) and 10 (5–20) mm, and the mean number of harvested lymph nodes was 21.7 (11–50). All cases had a complete or nearly complete mesorectal plane of surgery. Conclusions: Although technically challenging, the initial results suggest that transanal TME could be a feasible, oncologically safe, and reproducible operation. However, more robust studies are required to assess the short- and long-term outcomes.