Anal preserving surgery for rectal cancer-TaTME surgery

Total mesorectal excision (TME) is the standard surgical procedure for middle and low rectal cancer. But in the actual operation process, the quality of TME will be affected by a variety of factors, such as high position of rectal cancer, obesity, pelvic stenosis patients with middle and low rectal cancer, etc. In recent years, Transanal total mesorectal excision (TaTME) has developed rapidly. The advantages of this operation are obvious, the difficulty of operation is reduced, the quality requirements of TME such as negative perioperative margin are guaranteed, and the anal preservation rate is improved.

Men with middle and low rectal cancer, pelvic stenosis, diabetes or obesity, including abdominal obesity, or low rectal tumor location, tumor, late T stage, intraoperative exposure of mesorectal plane is difficult, and traditional TME surgery is difficult to introduce surgical instruments from top to bottom along the narrow bony pelvis. The anatomy of mesorectal membrane is not accurate, and the distal margin cannot be guaranteed. Under the above conditions, traditional surgery is difficult, and TaTME is feasible.

In addition, after neoadjuvant therapy for rectal cancer, patients strongly require anal preservation, and salvage surgical TME, TaTME can be selected. Meta-analysis showed that: Compared with Laparoscopic total mesorectal excision (LTME), TaTME has better mesangial resection quality, circumferential margin, intraoperative bleeding, complications, conversion to open surgery and other indicators, but there is no significant difference in postoperative recurrence and 2-year overall survival rate. Compared with robotic total mesorectal excision (RTME), there is no significant difference in histopathological parameters and postoperative complications of TaTME in the treatment of middle and low rectal cancer.