Beyond transanal total mesorectal excision: short‐term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision

• Published in: Colorectal disease Vol. 23; no. 4; pp. 823 - 833
• Main Authors: Larach, José Tomás, Rajkomar, Amrish K. S., Smart, Philip J., McCormick, Jacob J., Heriot, Alexander G., Warrier, Satish K.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2021
• Subjects: Cancer; extended resection; Fascia; Intestine; Lymph nodes; Metastases; Radiation therapy; rectal cancer; Rectum; Seminal vesicle; Sepsis; taTME; total mesorectal excision; transanal TME; Uterus; Vagina; transanal TME; extended resection; rectal cancer; taTME; total mesorectal excision
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.15446

Aim
The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane.
Method
We performed a retrospective review of the outcomes of a case series of patients undergoing taTME for rectal cancer with mesorectal fascia or adjacent organ involvement.
Results
Eleven patients (six men) underwent taTME for LARC requiring resection beyond total mesorectal excision (TME). All had a restorative procedure. The transabdominal approach was open in five and minimally invasive in six cases. All patients required the resection of at least one adjacent structure, including presacral fascia, internal iliac vessels, nerve roots, uterus, vagina or seminal vesicles. Four patients required a pelvic side‐wall lymph node dissection and four had intraoperative radiotherapy. In all cases, the transanal approach was useful to disconnect the rectum distally, resect adjacent organs or control the R1 risk‐point. Three patients had a complication of Clavien–Dindo grade III or above (one mechanical bowel obstruction, one pelvic collection and one urine sepsis). There were no anastomotic complications. Ten patients had an R0 resection. During a median follow‐up of 11 (8.6–16) months there were no local recurrences, but two patients had distant metastases. During the study period, eight patients underwent closure of their stoma whilst the remaining three have had normal anastomotic assessments and will be closed in the future.
Conclusion
This early series shows that implementation of taTME for resections beyond TME may be feasible and safe in a highly selected setting.