Page 246 - Read Online

Kim et al. Mini-invasive Surg 2019;3:33 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.23

Review Open Access

Transanal total mesorectal excision: current East
Asian perspectives for the future

Ho Seung Kim, Nam Kyu Kim
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul
03722, South Korea.
Correspondence to: Prof. Nam Kyu Kim, Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei
University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, South Korea. E-mail: namkyuk@yuhs.ac
How to cite this article: Kim HS, Kim NK. Transanal total mesorectal excision: current East Asian perspectives for the future.
Mini-invasive Surg 2019;3:33. http://dx.doi.org/10.20517/2574-1225.2019.23

Received: 10 Aug 2019 First Decision: 24 Oct 2019 Revised: 6 Nov 2019 Accepted: 13 Nov 2019 Published: 22 Nov 2019

Science Editor: Giulio Belli Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Transanal total mesorectal excision (TaTME) is widely performed for the resection of rectal cancer around the world.
However, due to lower body mass index and a lack of necessity, TaTMEs have not been accepted in East Asia as generally
as in Western countries. In East Asia, conventional laparoscopic surgeries have been performed with lower rates of open
conversions and robotic surgery has been considered as an acceptable option for patients with narrow pelvis. This review
article discusses TaTMEs from an East Asian perspective.

Keywords: Transanal total mesorectal excision, East Asia, robotic surgery, laparoscopic surgery, difficult pelvis

INTRODUCTION
The evaluation and management of rectal cancer has evolved remarkably over the last few decades since
[1]
Heald et al. proposed and reported on total mesorectal excisions for rectal cancer in the reduction of
local recurrences. Total mesorectal excision (TME) became the gold standard for curative resection from
the standpoint of control and survival. In addition to increased anatomical knowledge, surgical instruments
have also improved. In the early 1990s, laparoscopic surgery was introduced and gradually used in colon
and rectal cancer treatments. Since several multicenter randomized trials reported potential short-term
benefits with oncological outcomes comparable to open surgeries, laparoscopic TMEs were adopted for
[2,3]
rectal cancer . However, several prospective trials failed to prove the non-inferiority of laparoscopy, citing
[4,5]
several reasons . Most of the reasons were attributed to the difficulty in ensuring a sufficient surgical
field in a narrow space. The three most common reasons for open conversions in the Colorectal Cancer

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.misjournal.net