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De Rosa et al. Mini-invasive Surg 2020;4:34 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.53

Review Open Access

Transanal total mesorectal excision for rectal
cancer: state of the art

Michele De Rosa , Greg Wynn , Fabio Rondelli , Graziano Ceccarelli 1
1
2
3
1 Department of General Surgery, "San Giovanni Battista Hospital", Foligno 06034, Italy.
2 Department of General and Colorectal Surgery, East Suffolk and North Essex Foundation NHS Trust, Colchester CO45JL,
United Kingdom.
3 Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
Correspondence to: Dr. Michele De Rosa, Department of General Surgery, “San Giovanni Battista” Hospital, Via M. Arcamone,
06034 Foligno (PG), Italy. E-mail: michele.derosa@nhs.net
How to cite this article: De Rosa M, Wynn G, Rondelli F, Ceccarelli G. Transanal total mesorectal excision for rectal cancer:
state of the art. Mini-invasive Surg 2020;4:34. http://dx.doi.org/10.20517/2574-1225.2019.53
Received: 3 Dec 2019 First Decision: 3 Feb 2020 Revised: 17 Apr 2020 Accepted: 29 Apr 2020 Published: 18 Jun 2020

Science Editor: Giulio Belli Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Total mesorectal excision remains the gold standard for surgical treatment for rectal cancer to achieve excellent
oncological outcomes. The transanal approach to the mesorectum was introduced to complement conventional
surgery so that technical difficulties related to the distal rectal dissection could be overcome. Since its introduction,
interest in transanal mesorectal excision has been growing and it appears that the benefits are maximal in patients
with mid-low rectal cancer where anatomical and pathological factors present the greatest challenges. Current
evidence demonstrates this approach is safe and feasible, with an acceptable morbidity profile, but with specific
complications related to the technique. Oncological and functional data seem comparable to the conventional
approaches, but most of the results come from small studies with short-term endpoints. Robotics, when available,
might potentially overcome the difficulty of distal rectal dissection with a shorter learning curve compared to the
transanal approach, but with higher costs. The aim of this review is to critically evaluate the available literature
concerning transanal total mesorectal excision so that we can better define its role in the management of rectal
cancer.

Keywords: Rectal cancer, total mesorectal excision, transanal total mesorectal excision, transanal surgery,
laparoscopy

INTRODUCTION
Total mesorectal excision (TME) remains the gold standard approach to the surgical treatment of rectal
[1]
cancer . The application of this key technical principle has represented a revolution in rectal cancer

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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