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Aubert et al. Mini-invasive Surg 2019;3:34 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.46

Opinion Open Access

Limits of transanal total mesorectal excision for low
and middle rectal cancer

Mathilde Aubert, Diane Mege, Yves Panis
Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy
92110, France.
Correspondence to: Dr. Yves Panis, Département de Chirurgie Colorectale, Hôpital Beaujon, 100 Boulevard du Général Leclerc,
Clichy 92110, France. E-mail: yves.panis@aphp.fr
How to cite this article: Aubert M, Mege D, Panis Y. Limits of transanal total mesorectal excision for low and middle rectal
cancer. Mini-invasive Surg 2019;3:34. http://dx.doi.org/10.20517/2574-1225.2019.46

Received: 27 Oct 2019 Accepted: 19 Nov 2019 Published: 29 Nov 2019

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

Keywords: Transanal total mesorectal excision, rectal cancer, oncological results, laparoscopic total mesorectal excision,
learning curve

[1]
Transanal total mesorectal excision (TaTME) is now considered as a new standard of care in the surgical
management of low and mid rectal cancer for many surgeons. The main argument is a supposed better
visualization of the difficult anatomical area represented by the low third rectum (considered as “a rectal
no man’s land”), thus allowing better nerve preservation, better resection margins, and better functional
[2,3]
outcomes than standard laparoscopic TME . This transanal approach is particularly interesting in
obese patients with narrow pelvis and/or bulky tumor. However, all the encouraging results are only
based on retrospective and comparative studies. Two randomized trials comparing TaTME and standard
[4,5]
laparoscopic TME from above are currently ongoing (GRECCAR 11 and COLOR III) , but their results
are not yet available. In addition, the surgical community highlights some concerns about the safety of this
procedure, especially regarding the occurrence of postoperative morbidity and some altered oncological
and functional long-term outcomes.

An alarming report of the Norwegian Colorectal Cancer Group about oncologic results after TaTME has
recently been published. This report was presented in January 2019 at the 9th Ahus Colorectal Symposium,
University of Oslo in Norway and highlighted a higher rate of local recurrence after TaTME in the
[6]
Norwegian national survey. Larsen et al. published the Norwegian moratorium, which was decided after
110 TaTME procedures. The reason was that, after only 11 months, a local recurrence was observed in

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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