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Aubert et al. Mini-invasive Surg 2019;3:34 I http://dx.doi.org/10.20517/2574-1225.2019.46 Page 3 of 4

[7]
failure occurred in 15.7% , which is similar or even higher than those reported after laparoscopic TME:
[17]
[16]
13% in the COLOR II trial and 10% in the CLASSIC trial . The Dutch TaTME registry reported a quite
[18]
similar rate of anastomotic leak: 16.5% after TaTME vs. 12.2% after laparoscopic TME . Thus, the idea
that leak rate would be lower after TaTME due to avoiding “dog ear” observed during stapled anastomosis
performed from above might be wrong, and finally the risk of leak is probably unrelated to the technique
used for performing TME.

Long-term functional result in rectal cancer surgery is an important endpoint. Concerning functional
[19]
results, a comparative study between TaTME and laparoscopic TME recently reported that functional
outcomes after TaTME were significantly worse than those after laparoscopic TME. Indeed, anorectal
symptoms, such as buttock pain (P = 0.011), diarrhea (P = 0.009), clustering of stools (P = 0.017), and
urgency (P = 0.032), significantly disfavored TaTME, as did the mean low anterior resection syndrome
score, which is worse after TaTME than laparoscopic TME: 26.18 vs. 20.61 (P = 0.054). These results suggest
that the use of a transanal device during the entire operating time could lead to a worse functional result,
which is already altered after standard colo-anal anastomosis.

To conclude, if TaTME appeared as an attractive alternative for mid and low rectal cancer surgery with
encouraging results in the first retrospective studies, some concerns have recently emerged, especially
regarding the oncological results and a higher rate of early and multifocal recurrence, leading the
Norwegian colorectal cancer group to cease TaTME in their country. Results of ongoing randomized
control trials are needed to consider or not TaTME as a standard of care in rectal cancer surgery.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed literature review and
interpretation: Aubert M, Mege D, Panis Y

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and
laparoscopic assistance. Surg Endosc 2010;24:1205-10.
2. de’Angelis N, Portigliotti L, Azoulay D, Brunetti F. Transanal total mesorectal excision for rectal cancer: a single center experience and