Rectal Cancer Surgery and TaTME surgery

To improve oncological and functional outcomes of patients with rectal cancer new surgical techniques are being developed. The adoption of the Total Mesorectal Excision (TME) technique has resulted in better oncological outcome in the last decades. The addition of neoadjuvant therapy has further improved oncological outcome. The minimal invasive laparoscopic resection of rectal cancer has shown to be safe and to result in improved short-term outcomes and reduced morbidity. Nevertheless, the laparoscopic resection of mid and low rectal cancer remains challenging due to the anatomy of the narrow pelvis and is associated with a relative high risk of resections with tumour involved circumferential resection margins (CRM) resulting in increased risk of recurrence.

The introduction of transanal single port surgery has led to the TaTME technique. In attempt to improve the quality of the TME procedure in low rectal cancer and further improve oncological results the transanal total mesorectal excision (TaTME) has been developed, in which the rectum is dissected transanally according to TME principles.  First series have been described since 2010 and although randomised evidence is still lacking this new technique has shown to be feasible and safe. The rectum including the total mesorectum is mobilised transanally in a reversed way with minimally invasive surgery including high quality imaging techniques. The TaTME technique for low and mid rectal cancer has shown to have potential benefits: better specimen quality with less CRM involvement, less morbidity as result of avoiding extraction wounds in the majority of patients and more sphincter saving rectal resections without compromising oncological outcomes. Currently, cohort series have demonstrated potential benefits of the TaTME for rectal cancer including a low rate of involved CRM, low morbidity rate and a high rate of sphincter saving procedures. Jurriaan Tuynman, MD, PhD,  colorectal surgeon has introduced the technique in the VU medical center Amsterdam in 2013. Colin Sietses, MD, PhD, Colorectal surgeon has introduced this technique in Netherlands, EDE, since 2012.