Results of transanal mesorectal excision for rectal cancer – single center experience

Introduction. Total mesorectal excision (TME) is a standard of rectal cancer surgery. Oncological results of laparoscopic surgery similar to open. High rate of conversion (16–33%) especially in case of obesity, narrow pelvis and prostate hypertrophy required needs for alternative approaches. Transanal TME – minimal invasive approach that offers advantage of comfortable mobilization and improvement of long term results, accordingly.

Aim. To evaluate advantage of trans-anal TME (TA-TME) in comparison to laparoscopic (Lap-TME).

Material and methods. From October 2013 – 88 patients with rectal carcinoma (cT2-4aNo-2Mo) were enrolled in prospective clinical study. 48 of them were operated with TA-TME and 40 – with traditional laparoscopic. Selection criteria included primary operable rectal cancer patients. Groups were equal in terms of tumor stage, age and BMI.

Results. Duration of surgery was 285 min (TA-TME), 295 min (Lap-TME) and median blood loss less than 100 ml. Postoperative stay was equal – 7 days. Transanal extraction of specimen was possible in 62% in TA-TME vs 34% in Lap-TME. Complications (Clavien-Dindo) were in 33,3% and 25,0% (TA-TME and Lap-TME), no statistically significant differences. Grade IIIb, IVb and V complications were 4,1% in TA-TME and 7,5% in Lap-TME, accordingly. With respect to final pathology – TA-TME group grade 3 TME – 65%, grade 2 – 25%, grade 1 – 10% vs 68%, 12% and 20% – Lap-TME group (p=0,398). «Positive» lateral margin was 6% in TA-TME group vs 10% in Lap-TME.

Conclusion. Short-term results of TA-TME had showed similar outcome that traditional laparoscopic. Further investigations of functional and long-term oncologic results are needed