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Essay: Transanal total mesorectal excision in UZ Brussels: A first experience

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  • Subject area(s): Health essays
  • Reading time: 2 minutes
  • Price: Free download
  • Published: 10 October 2015*
  • File format: Text
  • Words: 288 (approx)
  • Number of pages: 2 (approx)

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Objective: The aim of this study is to appraise the feasibility and safety of a transanal total mesorectal excision (TaTME) with abdominal laparoscopic assistance.
Background: Over the past one hundred years rectal cancer surgery progressed excessively. The first step into making rectal cancer curable was achieved by Miles in 1908 performing an abdominoperineal resection. This was associated with reduced recurrence rates from 95% to 29,5%, but resulted in urogenital dysfunction. Later on, in 1948, Dixon developed a new sphincter sparing technique, further decreasing the mortality rates and also increasing the patient’s quality of life after rectal surgery. Finally, Heald implemented a TME-technique, even more reducing the recurrence rates from 20% to around 4%. Given the high morbidity incidence of open rectal surgery such as bowel damage and nerve damage, resulting in urinary and sexual dysfunction, new techniques are being developed in order minimize these side effects. Here fore, laparoscopic TME was introduced in the early nineties and resulted in a better view of the surgical field which refined the dissection. A transanal approach for rectal tumors has emerged recently to overcome some of the restrictions of laparoscopic surgery, hereby hopefully decreasing the conversion rates to open surgery and decreasing even more the morbidity rates after surgery.
Method: Between July 2014 and March 2015, 8 patients with rectal cancer located between 3,5 – 13cm from the anal verge underwent a rectum resection with total mesorectal excision by means of a transanal TME with abdominal laparoscopic assistance.
Results: Transabdominal – transanal resection of the complete rectum and mesorectum has proven successful for all patients concerned. All specimens had clear margins and all but one had a good mesorectal quality. An average of 16 lymph nodes were harvested. Mean operative time was 331 min and mean hospital stay was 15 days with a 0% mortality rate.

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