Transanal total mesorectal excision: A valid option for rectal cancer?

Table 1 Transanal total mesorectal excision and peri-operative outcomes (case series with n≥ 5)

Ref.	Number of patients	ORT	Conversion rate	Complications rate	LOS	Comment
Marks et al[25], 2010	79	NA	2.5%	29.9%	5	TATA approach
Tuech et al[22], 2015	56	270	7.3%	26%	10	-
Han et al[39], 2013	34	151.6	0	6 leaks	9	13 with low rectal tumors, 15 with upper rectal tumors and 6 with sigmoid tumors.
Rouanet et al[21], 2013	30	304	7%	Intraop: 10%	14	Difficult patients (male, high BMI, CRM threatened…)
				Postop: 30%
Muratore et al[20], 2015	26	241	NA	26.9%	NA	-
Atallah et al[17], 2014	20	243	NA	65%	4.5	-
Buchs et al[44], 2015	20	315.3	15%	30%	7	3 benign cases
de Lacy et al[18], 2013	20	234	0	20%	6.5	No readmission
Chouillard et al[29], 2014	16	265	6.25%	18.8%	10.4%	-
Wolthuis et al[43], 2014	14	148	18%	42.9%	8.8	No readmission
Knol et al[40], 2015	10	235	0	10%	6	-
Velthuis et al[42], 2013	5	175	0	40%	NA	-
Sylla et al[41], 2013	5	274.6	0	60%	5.2

BMI: Body mass index in kg/m²; ORT: Operative time in minutes; LOS: Length of stay in days; NA: Not available; TATA: Transabdominal-transanal.

Table 2 Transanal total mesorectal excision and pathological outcomes (case series with n≥ 5)

Ref.	TME quality	Positive CRM	Distal margins	LN
Marks et al[25]	NA	6.3%	1.9 cm	11.4
Tuech et al[22]	84% intact and 16% nearly intact	5.4%	1 cm	12
Han et al[39]	NA	0%	2.43	12.9
Rouanet et al[21]	100% good	13.3%	0.9 cm	13
Muratore et al[20]	88.5% complete	0%	1.9 cm	10
Atallah et al[17]	89.5% complete or nearly complete	5%	5% positive	22.5
Buchs et al[44]	94.1% intact and 5.9% nearly intact	5.9%	2.14 cm	23.2
De Lacy et al[18]	100% satisfactory	0%	2.6 cm	15.9
Chouillard et al[29]	100% intact	0%	3.6 cm	21
Wolthuis et al[43]	NA	NA	NA	NA
Knol et al[40]	90% intact	0%	1.94 cm	10.5
Velthuis et al[42]	100% intact	0%	0 positive	12
Sylla et al[41]	100% intact	0%	0 positive	33

TME: Total mesorectal excision; CRM: Circumferential resection margins; LN: Lymph nodes; NA: Not available.

Table 3 Comparative studies and peri-operative outcomes

Ref.	Number of patients	ORT	Conversion rate	Complications rate	LOS	Readmission
Denost et al[46], 2014	50 lap TME	263	10%	44%	8	NR
	50 Perineal TaTME1	240	4%	32%	7
Fernandez-Hevia et al[19], 2015	37 lap TME	252	0	51%	9	22%
	37 TaTME	215	0	32%	6.8	6%
Velthuis et al[23], 2014	25 lap TME	NR	NR	NR	NR	NR
	25 TaTME

¹Perineal dissection. No use of laparoscopic instruments. Lap: Laparoscopy; TaTME: Transanal total mesorectal excision; ORT: Operative time in minutes; LOS: Length of stay in days; NR: Not reported.

Table 4 Comparative studies and pathological outcomes

Ref.	Group	TME quality	Positive CRM	Distal margins	LN
Denost et al[46]	Lap TME	62% complete	18%	1 cm	17
	Perineal TaTME1	70% complete	4%	1 cm	17
Fernandez-Hevia et al[19]	Lap TME	94.6% complete	0	1.7 cm	14.7
	TaTME	91.9% complete	0	2.8 cm	14.3
Velthuis et al[23]	Lap TME	72% complete	8%	2.5 cm	13
	TaTME	96% complete	4%	2.3 cm	14

¹Perineal dissection. No use of laparoscopic instruments. Lap: Laparoscopy; TaTME: Transanal total mesorectal excision; CRM: Circumferential resection margins; LN: Lymph nodes.

Table 5 Robotic transanal total mesorectal excision

Ref.	Number of patients	ORT	Complications	LOS	Comments
Huscher et al[51], 2015	7	165.7	1 rectal bleeding, requiring blood transfusion	4.8	Negative margins, 6 complete and one nearly complete TME
Gomez Ruiz et al[50], 2015	5	398	1 anastomotic leak	6	Negative margins, complete TME
Atallah et al[48], 2014	3	376	Pulmonary embolism, stoma high output	4.3	All complete or nearly complete TME. Negative margins
Atallah et al[49], 2013	1	381	0	3	Negative margins, nearly complete TME
Verheijen et al[52], 2014	1	205	0	3	Negative margins, complete TME

ORT: Operative time in minutes; LOS: Length of stay in days.