New approach method in minimally invasive surgery for rectal cancer: transanal endoscopic surgery

Abstract Introduction: Apply and assess the early results of Transanal Total Mesorectal Excision (TaTME) for mid and low rectal cancer. Material and Methods: A prospective study in 45 patients (31 men and 14 women) suffering from mid and low rectal cancer, undergoing TaTME in Department of Gastrointestinal Surgery, 108 Military Central Hospital, from July 2017 to August 2018. Results: Pre-operative stages were mrT2: 8.9%, mrT3: 66.7%, mrT4a: 11.1%; mrTx: 13.3%. mrN (+): 73.3%, mrN(-): 20%, mrNx: 6.7%. The mean age was 64.56 ± 10.97 years, the mean body mass index was 20.5 ± 2.5 kg/m2. Low rectal cancer was 60% and mid rectal cancer was 40%. The mean operative duration was 145.33 ± 22.47 minutes. Operative morbidity rate was 33.3%, no operative mortality was detected. The macroscopic quality assessment of the resected specimen was complete in 77.8% nearly complete in 17.8%, the distal resection margin negative rate was 100% and the circumferential resection margin negative rate was 88.9%; The mean number of harvested lymph nodes was 4.52 ± 3.74. Postoperative stages were pT0: 6.7%, pT1: 2.2%, pT2: 31.1%, pT3: 53.3%, pT4a: 6.7%; pN-: 68.9%, pN+: 31.1%. Kirwan classification in anorectal function after 6 to 9 months of the operation was: Kirwan I and Kirwan II: 81.2%. Conclusion: TaTME technique was feasible and safe with the good early outcomes, the high-quality of TME specimens and sphincter-sparing resections for treatment in mid and low rectal cancer.