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Table 3. Transanal endoscopic microsurgery
Group Sample Level of
Ref. Study type Randomization Follow up Questionnaires Main findings
studied size evidence
Allaix et al. [39] , 2011 Prospective No TEM 93 60 months Wexner, FIQL, -TEM had mild fecal 4
single EORTC QLQ- incontinence postop
center C30, QLQ-CR38, which returned to
EQ5D baseline by 60
months
-Study group had be-
nign and malignant
lesions
Jakubauskas et al. [40] , Prospective No TEM 132 96 months Wexner, EQ5D -TEM had similar 4
2018 single fecal incontinence
center scores compared to
historic lap scores,
but better than open
surgery
-Study group had be-
nign and malignant
lesions
Hompes et al. [41] , 2015 Prospective No TEM 102 12 months EORTC QLQ- -TEM had mild fecal 4
single C30, QLQ-CR29, incontinence postop
center EQ5D which returned to
baseline by 26 weeks
-TEM had overall
QOL effects which
were transient
-TEM had no effect
on urinary function
-Study group had be-
nign and malignant
lesions
D’Ambrosio et al. [42] , Prospective No Neoad- 31 (15 12 months EORTC QLQ-C30, -TEM had improved 2b
2016 single juvant TEM, QLQ-CR38 overall QOL at 1, 6,
center TEM vs. 16 lap 12 months than lap
Lap TME TME) TME
TEM: transanal endoscopic microsurgery; Lap: laparoscopic; TME: total mesorectal excision; QOL: quality of life; EORTC QLQ-C30:
European organization for research and treatment of cancer quality of life questionnaire, 30 cancer non-specific questions; EORTC QLQ-
CR38: European organization for research and treatment of cancer quality of life questionnaire, 38 colorectal cancer specific questions;
EORTC QLQ-CR29: European organization for research and treatment of cancer quality of life questionnaire, 29 colorectal cancer specific
questions; FIQL: Fecal Incontinence Quality of Life Scale; EQ5D: European quality of life 5 dimensions questionnaire; Wexner: Wexner
Fecal Incontinence Score; Level of evidence: 1: randomized controlled trial; 2a: randomized prospective cohort study; 2b: nonrandomized
prospective cohort study; 3: retrospective cohort study; 4: case series

score compared to the control group. The authors described this as a “rejoice phenomenon” when the pa-
tient describes improved mental health after surgery with relief that a malignancy has been successfully ex-
cised. The study therefore concluded that TAMIS patients have similar quality of life compared to healthy
controls, and social function is decreased which may or may not be related to fecal incontinence .
[45]
A summary of studies examining quality of life after TAMIS for rectal cancer is found in Table 4.

TaTME
TaTME is an emerging technique for the treatment of mid and low rectal cancer referred to as a “bottom-
[46]
up” approach or transanal proctectomy described by Sylla et al. in 2010. Advocates attribute the benefits
of the technique to decrease the “coning in” effect of conventional TMEs that may result in an incomplete
distal mesorectal excision. Additionally, the technique is purported to allow for accurate identification
of the distal resection margins, increased rate of sphincter preservation, and reduced sexual and urinary
dysfunction. It is believed to be most beneficial for patients with narrow pelvises and excessive visceral fat.
Others believe the technique results in lower conversion rates and reduced wound-related complications.
However, major concerns about the technique include having a low tenuous anastomosis closer to the anal
sphincter compared to laparoscopic or robotic TME, as well as anal sphincter damage caused by prolonged